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Sample records for banded sleeve gastrectomy

  1. Laparoscopic Sleeve Gastrectomy versus Laparoscopic Banded Sleeve Gastrectomy: First Prospective Pilot Randomized Study

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    Valeria Tognoni

    2016-01-01

    Full Text Available Introduction. The placement of ring or band around the gastric tube might prevent the dilation after Laparoscopic Sleeve Gastrectomy (LSG. We describe the first randomized study comparing LSG and Laparoscopic Banded Sleeve Gastrectomy (LBSG. Material and Method. Fifty obese patients were enrolled in the study between January 2014 and January 2015. We analysed differences in operative time, complication rate, mortality, and BMI between the two groups over a period of 12 months. Results. Twenty-five patients received LSG (group A and 25 LBSG (group B. The mean preoperative BMI was 47.3±6.58 kg/m2 and 44.95±5.85 kg/m2, respectively, in the two groups. There was no statistical relevant difference in operative time. No intraoperative complications occurred. Mean BMI registered after 3, 6, and 12 months in groups A and B, respectively, were 37.86±5.72 kg/m2 and 37.58±6.21 kg/m2 (p=0.869, 33.64±6.08 kg/m2 and 32.03±5.24 kg/m2 (p=0.325, and 29.72±4.40 kg/m2 and 27.42±4.47 kg/m2 (p=0.186; no statistical relevant difference was registered between the two groups. Conclusion. LBSG is a safe and feasible procedure. The time required for the device positioning did not influence significantly the surgical time. The results of bodyweight loss did not document any statistically significant differences among the two groups, even though LBSG group showed a mean BMI slightly lower than that of the control group.

  2. Endoscopic Sleeve Gastroplasty, Laparoscopic Sleeve Gastrectomy, and Laparoscopic Band for Weight Loss: How Do They Compare?

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    Novikov, Aleksey A; Afaneh, Cheguevara; Saumoy, Monica; Parra, Viviana; Shukla, Alpana; Dakin, Gregory F; Pomp, Alfons; Dawod, Enad; Shah, Shawn; Aronne, Louis J; Sharaiha, Reem Z

    2018-02-01

    Endoscopic sleeve gastroplasty (ESG) is a novel endobariatric procedure. Initial studies demonstrated an association of ESG with weight loss and improvement of obesity-related comorbidities. Our aim was to compare ESG to laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB). We included 278 obese (BMI > 30) patients who underwent ESG (n = 91), LSG (n = 120), or LAGB (n = 67) at our tertiary care academic center. Primary outcome was percent total body weight loss (%TBWL) at 3, 6, 9, and 12 months. Secondary outcome measures included adverse events (AE), length of stay (LOS), and readmission rate. At 12-month follow-up, LSG achieved the greatest %TBWL compared to LAGB and ESG (29.28 vs 13.30 vs 17.57%, respectively; p ESG had a significantly lower rate of morbidity when compared to LSG or LAGB (p = 0.01). The LOS was significantly less for ESG compared to LSG or LAGB (0.34 ± 0.73 vs 3.09 ± 1.47 vs 1.66 ± 3.07 days, respectively; p ESG is a safe and feasible endobariatric option associated with low morbidity and short LOS in select patients.

  3. Vertical sleeve gastrectomy

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    ... clots , infection Risks for vertical sleeve gastrectomy are: Gastritis (inflamed stomach lining), heartburn, or stomach ulcers Injury ... of the work. To lose weight and avoid complications from the procedure, you will need to follow ...

  4. Leaks in fixed-ring banded sleeve gastrectomies: a management approach.

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    Foo, Jonathan W; Balshaw, James; Tan, Michael H L; Tan, Jeremy T H

    2017-08-01

    The use of a Fobi ring to prevent pouch dilation is sometimes used in Roux-en-Y gastric bypass (RYGB). Recently, it has been extrapolated to laparoscopic sleeve gastrectomy (LSG) procedures by placing a fixed-ring band a few centimeters below the gastroesophageal junction (GEJ). What is the consequence if a patient develops a leak? Tertiary metropolitan referral center, Australia. Over 18 months, all patients with either a conventional LSG or a fixed-ring banded sleeve gastrectomy (BLSG) who presented with a proven leak complication were included. The management approaches along with the surgical, endoscopic, and percutaneous procedures used were examined. Six patients had a BLSG leak and 6 had a LSG leak. All patients had leak resolution. There was no significant difference in body mass index (BMI), time to leak, initial white cell count (WCC), and C-reactive protein (CRP) levels between the 2 groups. LSG patients required a median of 2 endoscopic procedures (range: 1-3). Stents were deployed in 3 patients. All BLSG patients required a single surgical intervention with laparoscopic washout, drainage, removal of band±feeding jejunostomy. One stent was deployed in 1 BLSG patient. BLSG leak resolution was found at 34±12 days versus 85±12 days in the LSG group (P< .05). The BLSG is a new modification of the sleeve gastrectomy procedure. This study presents a management strategy for leak resolution employed in BLSG patients. The presence of a foreign body as a persistent nidus of infection mandates band removal. Copyright © 2017 American Society for Bariatric Surgery. All rights reserved.

  5. Normal alcohol metabolism after gastric banding and sleeve gastrectomy: a case-cross-over trial.

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    Changchien, Eric M; Woodard, Gavitt A; Hernandez-Boussard, Tina; Morton, John M

    2012-10-01

    Severe obesity remains the leading public health concern of the industrialized world, with bariatric surgery as the only current effective enduring treatment. In addition to gastric bypass, gastric banding and sleeve gastrectomy have emerged as viable treatment options for the severely obese. Occasionally, poor postoperative psychological adjustment has been reported. It has been previously demonstrated that breath alcohol content (BAC) levels and time to sober were increased in postoperative gastric bypass patients. The aim of this study was to examine whether alcohol metabolism in patients undergoing restrictive-type bariatric procedures is also altered. Nine patients undergoing laparoscopic adjustable gastric banding (LAGB) and 7 patients undergoing laparoscopic sleeve gastrectomy (LSG) were recruited. Preoperatively, 3-month and 6-month BAC and time to sober were measured after administration of 5 ounces of red wine. In addition, participants were asked to complete a questionnaire of drinking habits. The 16 total participants achieved a mean 44.7% 6-month excess weight loss. There were no significant changes in peak BAC or time to sober from preoperative levels (0.033%, 67.8 min, respectively) to 3 months (0.032%, 77.1 min, respectively, p = 0.421) or 6 months (0.035%, 81.2 min, respectively, p = 0.198). Patients undergoing LAGB and LSG do not share the same altered alcohol metabolism as seen in gastric bypass patients. However, all bariatric surgery patients should be counseled regarding alcohol use. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Effectiveness and Safety of Sleeve Gastrectomy, Gastric Bypass, and Adjustable Gastric Banding in Morbidly Obese Patients: a Multicenter, Retrospective, Matched Cohort Study

    NARCIS (Netherlands)

    Dogan, K.; Gadiot, R.P.; Aarts, E.O.; Betzel, B; Laarhoven, C.J. van; Biter, L.U.; Mannaerts, G.H.; Aufenacker, T.J.; Janssen, I.M; Berends, F.J.

    2015-01-01

    BACKGROUND: Laparoscopic adjustable gastric band (LAGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most performed procedures worldwide (92 %) nowadays. However, comparative clinical trials are scarce in literature. The objective of this study

  7. Conversion of failed laparoscopic adjustable gastric banding: sleeve gastrectomy or Roux-en-Y gastric bypass?

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    Moon, Rena C; Teixeira, Andre F; Jawad, Muhammad A

    2013-01-01

    In the literature, late complications and treatment failures in laparoscopic adjustable gastric banding (LAGB) have been reported. When the patient presents with failure of LAGB, surgeons have the option to convert it to a different procedure. The aim of our study is to evaluate and compare the safety and efficacy of converting LAGB to laparoscopic sleeve gastrectomy (LSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB). Between March 2008 and October 2012, a total of 54 patients underwent conversion of LAGB at our institution. Of these patients, 41 (75.9%) were converted to LRYGB, and 13 (24.1%) patients were converted to LSG. A retrospective review of a prospectively collected database was performed, noting the outcomes and complications of the procedure. Mean body mass index at the time of conversion was 41.8±6.5 kg/m(2) in LRYGB and 39.0±6.6 kg/m(2) in LSG. Mean percentage of excess weight loss was 57.4%±17.0% and 62.4%±19.6% in LRYGB, and it was 47.7%±4.2% and 65.6%±34.5% in LSG at 12 months (P>.34) and 24 months (P>.79) after conversion. Of LRYGB patients, 7 (17.5%) were readmitted as a result of abdominal pain, dehydration, and nausea/vomiting, and 4 (10.0%) patients required reoperation. One LSG patient (8.3%) was readmitted for new-onset severe reflux and underwent hiatal hernia repair. She was converted to LRYGB 32 months after the LSG procedure. Readmission rate (P>.61) and reoperation rate (P>.63) did not show statistical difference between the 2 procedures. Converting LAGB to LSG and LRYGB both seem feasible and resulted in substantial further weight loss. Copyright © 2013 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  8. Comparison of percentage excess weight loss after laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding

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    Bobowicz, Maciej; Lech, Paweł; Orłowski, Michał; Siczewski, Wiaczesław; Pawlak, Maciej; Świetlik, Dariusz; Witzling, Mieczysław; Michalik, Maciej

    2014-01-01

    Introduction Laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) are acceptable options for primary bariatric procedures in patients with body mass index (BMI) 35–55 kg/m2. Aim The aim of this study is to compare the effects of these two bariatric procedures 6, 12 and 24 months after surgery. Material and methods Two hundred and two patients were included 72 LSG and 130 LAGB patients. The average age was 38.8 ±11.9 and 39.4 ±10.4 years in LSG and LAGB groups, with initial BMI of 44.1 kg/m2 and 45.2 kg/m2, p = NS. Results The mean percentage of excess weight loss (%EWL) at 6 months for LSG vs. LAGB was 36.3% vs. 30.1% (p = 0.01) and at 12 months was 43.8% vs. 34.6% (p = 0.005). The greatest difference in the mean %EWL at 12 months was observed in patients with initial BMI of 40–49.9 kg/m2 in favor of LSG (47.5% vs. 35.6%; p = 0.01). Two years after surgery there was no advantage of LSG and in the subgroup of patients with BMI 50–55 kg/m2 there was a trend in favor of LAGB (57.2% vs. 30%; p = 0.07). The multiple regression model of independent variables (age, gender, initial BMI and the presence of comorbidities) proved insignificant in prediction of the best outcome in means of %EWL for either operative modality. None of these factors in the logistic regression model could determine the type of surgery that should be used in particular patients. Conclusions During the first 2 years after surgery, the best results were obtained in women with lower BMI undergoing LSG surgery. The LSG provides greater %EWL after a shorter period of time though the difference decreases in time. PMID:25337157

  9. Longitudinal sleeve gastrectomy: current perspectives

    Directory of Open Access Journals (Sweden)

    Soricelli E

    2014-05-01

    Full Text Available Emanuele Soricelli, Giovanni Casella, Giorgio Di Rocco, Adriano Redler, Nicola BassoDepartment of Surgical Sciences, Policlinico Umberto I, Sapienza, University of Rome, ItalyAbstract: Since the early 2000s, laparoscopic sleeve gastrectomy has increasingly gained consensus in bariatric surgery, thanks to good to excellent results in terms of weight loss and comorbidity resolution, and to simpler technical aspects than in Roux-en-Y gastric bypass and biliopancreatic diversion. In yearly consensus summits, surgical indications, technical details, and management of complications, together with continuous update of data concerning clinical outcome, have been debated on the basis of increasing collective experience. In experimental studies and clinical trials, the pathophysiological mechanisms of weight loss and remission of cardiometabolic comorbidities subsequent to sleeve gastrectomy have been extensively discussed. The aim of this paper is to offer a review of state of the art laparoscopic sleeve gastrectomy and to focus attention on the currently most debated topics and future prospects of this procedure.Keywords: sleeve gastrectomy, type 2 diabetes mellitus, gastroesophageal reflux disease, revisional, quality of life

  10. Longitudinal sleeve gastrectomy: current perspectives

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    Basso, Nicola; Soricelli,Emanuele; Casella,Giovanni; Di Rocco,Giorgio; Redler,Adriano

    2014-01-01

    Emanuele Soricelli, Giovanni Casella, Giorgio Di Rocco, Adriano Redler, Nicola BassoDepartment of Surgical Sciences, Policlinico Umberto I, Sapienza, University of Rome, ItalyAbstract: Since the early 2000s, laparoscopic sleeve gastrectomy has increasingly gained consensus in bariatric surgery, thanks to good to excellent results in terms of weight loss and comorbidity resolution, and to simpler technical aspects than in Roux-en-Y gastric bypass and biliopancreatic diversion. In yearly consen...

  11. Conversional Weight Loss Surgery: an Australian Experience of Converting Laparoscopic Adjustable Gastric Bands to Laparoscopic Sleeve Gastrectomy.

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    Devadas, M; Ku, D J

    2018-02-17

    Bariatric surgery is the most effective treatment for severe obesity, capable of producing more than 50% excess weight loss at 10-year follow-up (James Clin Dermatol 1; 22:276-80; O'Brien Br J Surg 2; 102:611-17; Buchwald et al. Metab Syndr 3; 347-56). The success of bariatric surgery extends far beyond weight loss, with up to 80-90% of patients having improvement or resolution of many of their weight-related co-morbidities including type II diabetes mellitus and hypertension (Puzziferri et al. JAMA 4; 312:934-42; Buchwald et al. Am J Med 5; 122:248-56). However, there is a paucity of data regarding conversional bariatric surgery. This study aims to explore the efficacy, safety and feasibility of conversional surgery. This study represents the largest Australasian series focusing on conversional bariatric surgery. The study was conducted in the Norwest Private Hospital and Hospital for Specialist Surgery (HSS), both private Hospitals in Sydney, Australia. Data was collected prospectively at regular intervals for more than 12 months from 1 January 2012 to 1st November 2015 for all patients requiring a laparoscopic sleeve gastrectomy (LSG) as secondary procedure after prior laparoscopic adjustable gastric band (LAGB). Excess weight loss (EWL), percentage total body weight loss (TWL) and excess BMI loss (EBMIL) as well as any complications were recorded. There were low rates of morbidity (1.1%) and no mortality at 12-month follow-up. Satisfactory EWL of 60% (95% CI: 56.6-63.4%), EBMIL of 60.1% (95% CI: 48.8-71.4%) and 16% TWL was achieved at 12-month follow-up. We therefore conclude that sleeve gastrectomy is a safe and valid option for conversional bariatric surgery following LAGB.

  12. Sleeve Gastrectomy and Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    Michael Laffin

    2013-01-01

    Full Text Available Bariatric surgery, when combined with lifestyle and medical interventions, is a common and successful treatment modality in the obese patient. Laparoscopic sleeve gastrectomy is one such procedure that has increased in popularity as a definitive bariatric operation. Although laparoscopic sleeve gastrectomy has been shown to be effective in producing weight loss and improving type 2 diabetes mellitus, its effect on gastroesophageal reflux disease (GERD has been inconsistent. This paper aims to summarize the available literature regarding GERD prevalence following laparoscopic sleeve gastrectomy, 8 studies demonstrate increased GERD prevalence, and 5 demonstrate decreased GERD prevalence following laparoscopic sleeve gastrectomy. The relationship between GERD and SG is complex and no clear relationship exists. The anatomic and physiologic changes caused by laparoscopic sleeve gastrectomy are discussed in the context of these inconsistent results.

  13. Gastritis in patients undergoing sleeve gastrectomy

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    Rath-Wolfson, Lea; Varona, Roy; Bubis, Golan; Tatarov, Alexander; Koren, Rumelia; Ram, Edward

    2017-01-01

    Abstract Laparoscopic sleeve gastrectomy (LSG) is a therapeutic option in severely obese patients. The aim of this study was to evaluate the presence of Helicobacter pylori (HP) gastritis and non-Helicobacter gastritis in the gastrectomy specimens, and its association to other variables. One hundred six sleeve gastrectomy specimens were examined histopathologically for the presence of gastritis and its relation to other factors like ethnicity, glycemic control, and postoperative complications...

  14. Laparoscopic sleeve gastrectomy after failed gastric banding: is it really effective? Six years of follow-up.

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    Carandina, Sergio; Genser, Laurent; Bossi, Manuela; Polliand, Claude; Tabbara, Malek; Barrat, Christophe

    2017-07-01

    Laparoscopic sleeve gastrectomy (LSG) has become a valuable surgical option to rescue laparoscopic adjustable gastric banding (LAGB) failures. The aim of this study was to determine whether conversion to LSG after failed LAGB (CLSG) is a well-tolerated and effective rescue procedure compared with primary LSG (PLSG) in the long term. University hospital, France. A retrospective review of data concerning consecutive patients receiving a LSG between February 2008 and December 2014 was conducted. Mortality, postoperative complications, and weight loss outcomes were analyzed. Of 701 LSG, 601 (85.7%) were PLSG and 100 (14.3%) were CLSG. The mortality rate was 0%. Overall morbidity was comparable between the primary and conversion group (10% versus 6%, P = .27). The mean percentage of excess weight loss at 3, 36, and 72 months was 34.9%, 72.1%, and 57.2% after PLSG and 22.6%, 51.2% and 29.8% after CLSG (P<.05). The failure rate (mean percentage of excess weight loss<50%) was higher in the CLSG group during the first 5 postoperative years (P < .001) with more than two thirds of the CLSG considered as having failed at 60 months. Patients who underwent band ablation as a result of insufficient weight loss or weight regain presented the worst results after conversion to LSG. In this study, the conversion of failed LAGB to LSG in 2 steps indicated a safety profile comparable to that of primary LSG but was significantly less effective from the early postoperative course (3 mo) up to 6 years postoperatively. CLSG may not be the best option because a third operation may be needed as a result of insufficient weight loss. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  15. Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy as Revisional Procedures after Adjustable Gastric Band: 5-Year Outcomes.

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    Angrisani, Luigi; Vitiello, Antonio; Santonicola, Antonella; Hasani, Ariola; De Luca, Maurizio; Iovino, Paola

    2017-06-01

    In 2013, a worldwide bariatric surgery survey showed that laparoscopic adjustable gastric banding (LAGB) has been abandoned in favor of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-y gastric bypass (LRYGBP). The aim of this study was to compare results of LRYGBP and LSG performed as a revisional procedure after LAGB. All patients converted from LAGB to LSG or to LRYGBP from January 2007 to December 2011 were included in the study. Clinical data collected were age, gender, indications for revision, complications, body mass index (BMI), and body weight at revisional procedures. Weight loss was calculated at 1, 3, and 5 years after conversion. Fifty-one patients were included in this study, 43 females and 8 males. Twenty-four patients were converted to LRYGBP (LRYGBP group) and 27 to LSG (LSG group). Indication for conversion was weight loss failure in 34 (67%) patients and band complications in 17 (33%) patients. No significant difference in age, BMI, and body weight in the two groups was found at the time of revision. One patient converted to LRYGBP had an internal hernia; one patient initially scheduled for LSG was intraoperatively converted to LRYGBP due to staple line leak. No other major perioperative complication was observed. Follow-up rate at 5 years was 84.3% (43 patients out of 51 patients) Delta-BMI and percentage of excess weight loss (%EWL) were not significantly different in the two groups at 1, 3, and 5 years (p > 0.05). LRYGBP or LSG are feasible and effective surgical options after LAGB. Satisfactory weight loss was achieved after both procedures.

  16. Bariatric surgery in elderly patients. A comparison between gastric banding and sleeve gastrectomy with five years of follow up.

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    Musella, Mario; Milone, Marco; Maietta, Paola; Bianco, Paolo; Coretti, Guido; Pisapia, Anna; Gaudioso, Dario; Milone, Francesco

    2014-01-01

    The prevalence of obesity is rising progressively, even among elderly patients. Many studies investigated about safety and efficacy of bariatric surgery among aged obese patients. The objective of this review is to assess the benefits relative to risks of weight loss that may be obtained by performing two common bariatric procedures in obese elderly patient. We retrospectively evaluated 10 morbid obese patients older than 60 years reaching 5 years of follow up who respectively underwent Laparoscopic Sleeve Gastrectomy (LSG) or Laparoscopic Adjustable Gastric Banding (LAGB). Eventual changes in comorbidities, weight loss, EWL% were investigated. Although LSG patients required a longer postoperative hospital stay than LAGB patients (p elderly patients. Whereas all patients showed comorbidities resolution, no significant difference in weight loss between LAGB group and LSG group was found at 1 year (EWL% p = 0.87; BMI p = 0.32), 3 years (EWL% p = 0.62; BMI p = 0.79) and 5 years (EWL% p = 0.52; BMI p = 0.46) of follow up. Bariatric surgery is safe and effective to reach obesity related comorbidities resolution among elderly obese patients. Both LAGB and LSG determine a weight loss lesser than observed in a standard bariatric population. In this study LSG is significantly less cost effective than LAGB. Larger studies with longer follow up are however needed to evaluate the real impact of bariatric surgery on weight loss, resolution of comorbidities and improvement of quality of life in elderly obese patients. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  17. Comparative effectiveness of 3 bariatric surgery procedures: Roux-en-Y gastric bypass, laparoscopic adjustable gastric band, and sleeve gastrectomy.

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    Lee, Jenny H; Nguyen, Quynh-Nhu; Le, Quang A

    2016-06-01

    Bariatric surgery is associated with improved co-morbidities, quality of life, and survival in severely obese patients. Common bariatric surgery procedures include Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric band (LAGB), and sleeve gastrectomy (SG). Currently, literature studying comparative effectiveness on different bariatric surgery procedures in veterans is limited. To compare effectiveness of 3 bariatric surgery procedures performed in veterans. Veterans Affairs Loma Linda Healthcare Systems (VALLHS), Loma Linda, California, United States. This study was a single-institution, retrospective cohort study. Primary outcome was weight reduction, expressed as kilograms lost, body mass index (BMI) reduction, percentage weight loss (%WL), and percentage excess weight loss (%EWL) after 12 months of bariatric surgery. Secondary outcomes were reduction in number of medications and laboratory markers for obesity-related chronic conditions. Inverse-probability weighting propensity score method was used to balance baseline characteristics among the procedures. A total of 162 patients were included in the study. At 12 months, the kilograms lost, BMI reduction, %WL, and %EWL were 40.7±14.5 kg, 13.4±4.1 kg/m(2), 31.5±8.5%, and 41.4±11.6% for RYGB; 24.4±22.1 kg, 7.9±7.3 kg/m(2), 20.2±21.5%, and 26.7±27.6% for SG; and 15.3±15.7 kg, 5.0±5.0 kg/m(2), 12.0±11.7%, and 16.1±15.9% for LAGB, respectively (RYGB versus SG, RYGB versus LAGB, and SG versus LAGB, all Psurgery procedure in patients who are not candidates for RYGB. Copyright © 2016 American Society for Bariatric Surgery. All rights reserved.

  18. The influence of laparoscopic adjustable gastric banding and laparoscopic sleeve gastrectomy on weight loss, plasma ghrelin, insulin, glucose and lipids

    Directory of Open Access Journals (Sweden)

    Hady Razak Hady

    2012-07-01

    Full Text Available The aim of this study was to assess the impact of laparoscopic gastric banding and laparoscopic sleeve gastrectomy on the concentration of ghrelin, insulin, glucose, triglycerides, total and HDL-cholesterol, as well as AST and ALT levels in plasma in patients with obesity. The research includes 200 patients operated using LAGB (34 men average age 37.0 ± 12.6 years and 66 women average age 39.18 ± 12.17 years and LSG (48 men average age 47.93 ± 9.24 years and 52 women, 19 ± 9.33 years. The percentage of effective weight loss, effective BMI loss, concentration of ghrelin, insulin, glucose, triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol, ALT, AST and HOMA IR values was taken preoperatively and at 7th day, 1 month, 3 and 6 months after surgery. Both after LSG and after LAGB, statistically significant reduction in BMI, serum insulin, glucose and HOMA IR was noticed in comparison to the preoperative values. Post LAGB, patients showed an increase of ghrelin, while LSG proved ghrelin decreased. Correlations between glucose and BMI loss, and between insulin and BMI loss in both cases are more favorable in the LSG group. Lipid parameters, AST and ALT have undergone declines or  increases in the particular time points. Both techniques cause weight loss and this way lead to changes in the concentration of ghrelin, as well as to the improvement of insulin, glucose, cholesterol and triglycerides metabolism. They reduce metabolic syndrome and multiple comorbidities of obesity.

  19. Single-stage revision from gastric band to gastric bypass or sleeve gastrectomy: 6- and 12-month outcomes.

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    Yeung, Louise; Durkan, Brandice; Barrett, Allison; Kraft, Cary; Vu, Kim; Phillips, Edward; Cunneen, Scott; Burch, Miguel

    2016-06-01

    Laparoscopic adjustable gastric banding (LAGB) is increasingly requiring revisional surgery for complications and failures. Removal of the band and conversion to either laparoscopic Roux-en-y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) is feasible as a single-stage procedure. The objective of this study is to compare the safety and efficacy of single-stage revision from LAGB to either LRYGB or LSG at 6 and 12 months postoperatively. Retrospective analysis was performed on patients undergoing single-stage revision between 2009 and 2014 at a single academic medical center. Patients were reassessed for weight loss and complications at 6 and 12 months postoperatively. Thirty-two patients underwent single-stage revision to LRYGB, and 72 to LSG. Preoperative BMIs were similar between the two groups (p = 0.27). Median length of stay for LRYGB was 3 days versus 2 for LSG (p = 0.14). Four patients in the LRYGB group required reoperation within 30 days, and two patients in the LSG group required reoperation within 30 days (p = 0.15). There was no difference in ER visits (p = 0.24) or readmission rates (p = 0.80) within 30 days of operation. Six delayed complications were seen in the LSG group with three requiring intervention. At 6 months postoperatively, percent excess weight loss (%EWL) was 50.20 for LRYGB and 30.64 for LSG (p = 0.056). At 12 months, %EWL was 51.19 for LRYGB and 34.89 for LSG (p = 0.31). There was no difference in diabetes or hypertension medication reduction at 12 months between LRYGB and LSG (p > 0.07). Single-stage revision from LAGB to LRYGB or LSG is technically feasible, but not without complications. The complications in the bypass group were more severe. There was no difference in readmission or reoperation rates, weight loss or comorbidity reduction. Revision to LRYGB trended toward higher rate and greater severity of complications with equivalent weight loss and comorbidity reduction.

  20. Weight Loss after Sleeve Gastrectomy in Super Superobesity

    Directory of Open Access Journals (Sweden)

    J.-M. Catheline

    2012-01-01

    Full Text Available Objective. This prospective study evaluated laparoscopic sleeve gastrectomy for its safety and efficiency in excess weight loss (%EWL in super superobese patients (BMI >60 Kg/m2. Results. Thirty patients (33 women and 7 men were included, with mean age of 35 years (range 18 to 59. Mean preoperative BMI was 66 Kg/m2 (range 60 to 85. The study included one patient with complete situs inversus and 4 (14% with previous restrictive gastric banding. The mean operative time was 120 minutes (range 80 to 220 min and the mean hospital stay was 7.5 days (4 to 28 days. There was no postoperative mortality or need for a laparotomy conversion. Two subphrenic hematomas, one gastric fistula, and one pulmonary embolism, were the major complications. After 18 months 17 (77% had sufficient weight loss and six had insufficient results, leading to either re-sleeve gastrectomy (3, or gastric bypass (2. Three years after the initial laparoscopic sleeve gastrectomy, the mean EWL was 51% (range 21 to 82. Conclusion. The laparoscopic sleeve gastrectomy is a safe and efficient operating procedure for treating super superobesity. In the case of insufficient weight loss, a second-stage operation like resleeve gastrectomy or gastric bypass can be proposed.

  1. A review of studies comparing three laparoscopic procedures in bariatric surgery: sleeve gastrectomy, Roux-en-Y gastric bypass and adjustable gastric banding.

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    Franco, Juan Victor A; Ruiz, Pablo Adrian; Palermo, Mariano; Gagner, Michel

    2011-09-01

    Obesity is a major worldwide problem in public health, reaching epidemic proportions in many countries, especially in urbanized regions. Bariatric procedures have been shown to be more effective in the management of morbid obesity, compared to medical treatments in terms of weight loss and its sustainability. The two most commonly performed procedures are laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic adjustable gastric banding (LAGB), and the novel laparoscopic sleeve gastrectomy (LSG). The MEDLINE database (cutoff date September 2010), LILACS, and the Cochrane Library were searched using the key words "gastric bypass," "sleeve gastrectomy," and "gastric banding." Only studies that compared at least two of the laparoscopic procedures were included. Reviews and meta-analysis, editorial letters or comments, case reports, animal or in vitro studies, comparisons with medical treatment, comparisons with open (non-laparoscopic) procedures were excluded. Most studies indicated that LRYGB and LSG could be more effective achieving weight loss than LAGB. However, LAGB seems to be a safer procedure with frequent, but less severe, long-term complications. Although not uniformly reported, a resolution of obesity-related comorbidities was achieved with most bariatric procedures. The three procedures have acceptable efficacy and safety. We believe that patients should be informed in detail on the advantages and disadvantages of each available procedure, possibly in several interviews and always accompanied by a specialized interdisciplinary team, warranting long-term follow-up.

  2. Association of Bariatric Surgery Using Laparoscopic Banding, Roux-en-Y Gastric Bypass, or Laparoscopic Sleeve Gastrectomy vs Usual Care Obesity Management With All-Cause Mortality.

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    Reges, Orna; Greenland, Philip; Dicker, Dror; Leibowitz, Morton; Hoshen, Moshe; Gofer, Ilan; Rasmussen-Torvik, Laura J; Balicer, Ran D

    2018-01-16

    Bariatric surgery is an effective and safe approach for weight loss and short-term improvement in metabolic disorders such as diabetes. However, studies have been limited in most settings by lack of a nonsurgical group, losses to follow-up, missing data, and small sample sizes in clinical trials and observational studies. To assess the association of 3 common types of bariatric surgery compared with nonsurgical treatment with mortality and other clinical outcomes among obese patients. Retrospective cohort study in a large Israeli integrated health fund covering 54% of Israeli citizens with less than 1% turnover of members annually. Obese adult patients who underwent bariatric surgery between January 1, 2005, and December 31, 2014, were selected and compared with obese nonsurgical patients matched on age, sex, body mass index (BMI), and diabetes, with a final follow-up date of December 31, 2015. A total of 33 540 patients were included in this study. Bariatric surgery (laparoscopic banding, Roux-en-Y gastric bypass, or laparoscopic sleeve gastrectomy) or usual care obesity management only (provided by a primary care physician and which may include dietary counseling and behavior modification). The primary outcome, all-cause mortality, matched and adjusted for BMI prior to surgery, age, sex, socioeconomic status, diabetes, hyperlipidemia, hypertension, cardiovascular disease, and smoking. The study population included 8385 patients who underwent bariatric surgery (median age, 46 [IQR, 37-54] years; 5490 [65.5%] women; baseline median BMI, 40.6 [IQR, 38.5-43.7]; laparoscopic banding [n = 3635], gastric bypass [n = 1388], laparoscopic sleeve gastrectomy [n = 3362], and 25 155 nonsurgical matched patients (median age, 46 [IQR, 37-54] years; 16 470 [65.5%] women; baseline median BMI, 40.5 [IQR, 37.0-43.5]). The availability of follow-up data was 100% for all-cause mortality. There were 105 deaths (1.3%) among surgical patients during a median follow

  3. Single-incision sleeve gastrectomy versus conventional laparoscopic sleeve gastrectomy--a randomised pilot study.

    Science.gov (United States)

    Lakdawala, Muffazal A; Muda, Nor Hisham; Goel, Sunita; Bhasker, Aparna

    2011-11-01

    This is a prospective pilot study done to evaluate the feasibility and to assess the outcomes and complication rates of the single-incision sleeve gastrectomy versus the conventional five-port laparoscopic sleeve gastrectomy. A prospective comparative analysis was done of 50 patients in each arm who underwent laparoscopic sleeve gastrectomy and single-incision sleeve gastrectomy from September 2009 until April 2010. Both groups were matched for age, gender and BMI and were then randomly assigned to either group. Postoperative pain scoring was done using the visual analogue scale. Postoperative outcomes in terms of pain scores, excess weight loss, resolution of comorbidities and complication rates were compared in both groups, at the end of 6 months. Operating times in both groups were comparable with experience. Intraoperative blood loss was similar in both groups. VAS scoring revealed lesser postoperative pain after the first 8 h in the single-incision group as compared to the laparoscopy group-P < 0.0001. At 6 months, excess weight loss and resolution of comorbidities were comparable in both groups. There were no major complications or mortalities in either group. Single-incision laparoscopic sleeve gastrectomy is a feasible surgical procedure for morbid obesity in selected individuals. When compared to conventional laparoscopic sleeve gastrectomy, it has equally effective weight loss and resolution of comorbidities. It also has the added benefits of little or no visible scarring and reduced postoperative pain.

  4. [EFFICIENCY "SLEEVE" GASTRECTOMY IN TREATMENT OF OBESITY].

    Science.gov (United States)

    Todurov, I M; Bilyansky, L S; Perekhrestenko, A V; Razdobudko, Yu M; Kucheruk, V V; Kalashnikov, O O; Kosyuhno, S V; Plehutsa, O I

    2015-06-01

    The possible mechanisms of clinical efficacy "sleeve" gastrectomy in patients with obe- sity were analysed. The metabolic effect transactions associated not only with reducing the volume of the stomach, but the acceleration passage of gastric contents of the tube and the small intestinp_

  5. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass.

    Science.gov (United States)

    Hutter, Matthew M; Schirmer, Bruce D; Jones, Daniel B; Ko, Clifford Y; Cohen, Mark E; Merkow, Ryan P; Nguyen, Ninh T

    2011-09-01

    To assess the safety and effectiveness of the laparoscopic sleeve gastrectomy (LSG) as compared to the laparoscopic adjustable gastric band (LAGB), the laparoscopic Roux-en-Y gastric bypass (LRYGB) and the open Roux-en-Y gastric bypass (ORYGB) for the treatment of obesity and obesity-related diseases. LSG is a newer procedure being done with increasing frequency. However, limited data are currently available comparing LSG to the other established procedures. We present the first prospective, multiinstitutional, nationwide, clinically rich, bariatric-specific data comparing sleeve gastrectomy to the adjustable gastric band, and the gastric bypass. This is the initial report analyzing data from the American College of Surgeons-Bariatric Surgery Center Network accreditation program, and its prospective, longitudinal, data collection system based on standardized definitions and collected by trained data reviewers. Univariate and multivariate analyses compare 30-day, 6-month, and 1-year outcomes including morbidity and mortality, readmissions, and reoperations as well as reduction in body mass index (BMI) and weight-related comorbidities. One hundred nine hospitals submitted data for 28,616 patients, from July, 2007 to September, 2010. The LSG has higher risk-adjusted morbidity, readmission and reoperation/intervention rates compared to the LAGB, but lower reoperation/intervention rates compared to the LRYGB and ORYGB. There were no differences in mortality. Reduction in BMI and most of the weight-related comorbidities after the LSG also lies between those of the LAGB and the LRYGB/ORYGB. LSG has morbidity and effectiveness positioned between the LAGB and the LRYGB/ORYGB for data up to 1 year. As obesity is a lifelong disease, longer term comparative effectiveness data are most critical, and are yet to be determined.

  6. First Report from the American College of Surgeons -- Bariatric Surgery Center Network: Laparoscopic Sleeve Gastrectomy has Morbidity and Effectiveness Positioned Between the Band and the Bypass

    Science.gov (United States)

    Hutter, Matthew M.; Schirmer, Bruce D.; Jones, Daniel B.; Ko, Clifford Y.; Cohen, Mark E.; Merkow, Ryan P.; Nguyen, Ninh T.

    2012-01-01

    Objective To assess the safety and effectiveness of the laparoscopic sleeve gastrectomy (LSG) as compared to the Laparoscopic Adjustable Gastric Band(LAGB), the Laparoscopic Roux-en-Y Gastric Bypass(LRYGB) and the Open Roux-en-Y Gastric Bypass(ORYGB) for the treatment of obesity and obesity-related diseases. Summary of Background Data LSG is a newer procedure being done with increasing frequency. However, limited data are currently available comparing LSG to the other established procedures. We present the first prospective, multi-institutional, nationwide, clinically-rich, bariatric-specific data comparing sleeve gastrectomy to the adjustable gastric band and the gastric bypass. Methods This is the initial report analyzing data from the American College of Surgeons – Bariatric Surgery Center Network accreditation program, and its prospective, longitudinal, data collection system based on standardized definitions and collected by trained data reviewers. Univariate and multivariate analyses compare 30-day, 6-month, and one-year outcomes including morbidity and mortality, readmissions and reoperations as well as reduction in body mass index (BMI) and weight-related comorbidities. Results 109 hospitals submitted data for 28,616 patients, from 7/2007 to 9/2010. The LSG has higher risk-adjusted morbidity, readmission and reoperation/intervention rates compared to the LAGB, but lower reoperation/intervention rates compared to the LRYGB and ORYGB. There were no differences in mortality. Reduction in BMI and most of the weight-related comorbidities following the LSG also lies between those of the LAGB and the LRYGB/ORYGB. Conclusion LSG has morbidity and effectiveness positioned between the LAGB and the LRYGB/ORYGB for data up to one year. As obesity is a lifelong disease, longer term comparative effectiveness data are most critical, and are yet to be determined. PMID:21865942

  7. Laparoscopic median gastrectomy for stenosis following sleeve gastrectomy.

    Science.gov (United States)

    Kalaiselvan, Ramya; Ammori, Basil J

    2015-01-01

    Laparoscopic sleeve gastrectomy (LSG) has become an established primary bariatric procedure. Gastric stenosis after LSG has been reported in a few studies and often occurs at the level of incisura or midbody because of a technical operative error and could be associated with a leak. This can be managed by endoscopic dilations or revision surgery. The objective of this study is to describe a novel technique to deal with sleeve stenosis and its outcome. Two patients presented with sleeve stenosis after LSG and underwent a novel technique. The patients were followed up for 18 months. We describe a novel technique of laparoscopic median gastrectomy in 2 patients that involved resection of the stenotic segment followed by a hand-sewn, gastrogastric, end-to-end anastomosis. Both patients had successfully recovered from stenosis related symptoms, although one required an endoscopic dilation of the anastomosis. Laparoscopic median gastrectomy is a feasible and effective option in patients who have failed conservative management of stenosis after LSG and in whom there is a desire to avoid seromyotomy or conversion to gastric bypass. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  8. Nutrient deficiencies before and after sleeve gastrectomy.

    Science.gov (United States)

    van Rutte, P W J; Aarts, E O; Smulders, J F; Nienhuijs, S W

    2014-10-01

    Obesity is associated with nutritional deficiencies. Bariatric surgery could worsen these deficiencies. Fewer nutritional deficiencies would be seen after sleeve gastrectomy compared to the Roux-en-Y gastric bypass, but sleeve gastrectomy would also cause further deterioration of the deficiencies. The aim of this study was to determine the amount of pre-operative nutrient deficiencies in sleeve gastrectomy patients and assess the evolution of the nutritional status during the first post-operative year. Four hundred seven sleeve gastrectomy patients were assigned to a standardized follow-up program. Data of interest were weight loss, pre-operative nutrient status and evolution of nutrient deficiencies during the first post-operative year. Deficiencies were supplemented when found. Two hundred patients completed blood withdrawal pre-operatively and in the first post-operative year. pre-operatively, 5 % of the patients were anemic, 7 % had low serum ferritin and 24 % had low folic acid. Hypovitaminosis D was present in 81 %. Vitamin A had excessive levels in 72 %. One year post-operatively, mean excess weight loss was 70 %. Anemia was found in 6 %. Low-ferritin levels were found in 8 % of the patients. Folate deficiency decreased significantly and hypovitaminosis D was still found in 36 %. In this study, a considerable amount of patients suffered from a deficient micronutrient status pre-operatively. One year after surgery, micronutrient deficiencies persisted or were found de novo in a considerable amount of patients, despite significant weight loss and supplementation. Significant reductions were seen only for folate and vitamin D.

  9. A Review of Sleeve Gastrectomy Specimen Histopathology.

    Science.gov (United States)

    Kinsinger, Luke A; Garber, James C; Whipple, Oliver

    2016-11-01

    With the increasing popularity of sleeve gastrectomy, many stomach specimens are being evaluated. Understanding the significance and treatment for unexpected pathology is important. This study examines the incidence of relevant histopathology of sleeve gastrectomy specimens. It evaluates previous data for each histopathology and provides recommendations for treatment. In this study, a retrospective review was performed for 241 patients who underwent sleeve gastrectomy from 2009 to 2014 at a single institution. Of the specimens, 122 had no significant histopathology, 91 had gastritis, 13 had lymphoid aggregates, 5 had hyperplasia, 3 had intestinal metaplasia, 3 had gastrointestinal stromal tumors (GISTs), and 3 had gastric polyps. Of the GISTs all had a low mitotic rate and the size of the tumor ranged from 1.5 to 4.5 cm. The findings of metaplasia may be a marker for increased risk of malignancy and may require additional surveillance. The findings of GIST may warrant interval imaging to survey for recurrence, though the likelihood of recurrence for the tumors in this study is less than 2 per cent based on previous studies.

  10. [Wernicke's encephalopathy following sleeve gastrectomy for morbid obesity].

    Science.gov (United States)

    Landais, A; Saint-Georges, G

    2014-11-01

    Bariatric restrictive interventions, as sleeve gastrectomy or gastric banding can cause metabolic complications, especially when vomiting is present, such as thiamine deficiency that can lead to Wernicke's encephalopathy. A 31-year-old man with a 47kg/m(2) body mass index presented with Wernicke's encephalopathy, with ophtalmoplegia, nystagmus, ataxia and confusion, followed by a Korsakoff syndrome, occurring two months after a sleeve gastrectomy. MRI showed hyperintense signals on T2 and FLAIR image in both thalamus, periaqueducal area and mamillary bodies. A close clinical and biological monitoring is required in the first year after surgery, especially if vomiting occurs. Early diagnostic and treatment are needed to avoid severe sequelae. Copyright © 2014 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  11. Safety Evaluation of Laparoscopic Sleeve Gastrectomy Compared with Two Procedures of Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Adjustable Gastric Banding for Individuals with Morbid Obesity: A Systemic Review

    OpenAIRE

    F Arabi Basharic; A Olyaee Manesh; M Ranjbar Ezzatabadi; R Goudarzi; SM Shiryazdi; M Arab zozani; MR Mobini Zade

    2015-01-01

    Introduction: Laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding are the most common bariatric surgery procedures. Therefore, this study aims to compare the safety of the newer procedure of Laparoscopic sleeve gastrectomy compared to Laparoscopic Roux-en-Y gastric bypass and Laparoscopic adjustable gastric bonding. Method: A systematic review was conducted on the most important and most relevant search data bases, including Cochrane library, Pubmed, Ovid Med...

  12. Safety Evaluation of Laparoscopic Sleeve Gastrectomy Compared with Two Procedures of Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Adjustable Gastric Banding for Individuals with Morbid Obesity: A Systemic Review

    Directory of Open Access Journals (Sweden)

    F Arabi Basharic

    2015-10-01

    Full Text Available Introduction: Laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding are the most common bariatric surgery procedures. Therefore, this study aims to compare the safety of the newer procedure of Laparoscopic sleeve gastrectomy compared to Laparoscopic Roux-en-Y gastric bypass and Laparoscopic adjustable gastric bonding. Method: A systematic review was conducted on the most important and most relevant search data bases, including Cochrane library, Pubmed, Ovid Medline as well as Iranian sites of Magiran , Iranmedex , SID, not taking the time limit into consideration. The results found in the literature were classified and were then analyzed. Results: Out of 384 articles obtained in the search, 4 randomized clinical trials (RCT were included in this study. There were no reports of death comparing surgical procedures of Roux-en-Y gastric bypass and sleeve gastrectomy. Moreover, in adjustable gastric banding and Roux-en-Y gastric bypass comparison, one death was observed in each group. Regarding the side effects of Roux-en-Y gastric bypass and sleeve gastrectomy, 10% early complications were reported in the Roux-en-Y gastric  bypass group , and 13% were observed in the sleeve gastrectomy group between which no statistically significant difference was revealed. The comparison between adjustable gastric banding and Roux-en-Y gastric bypass demonstrated that the occurrence of early and late complications was reported to be higher in the gastric bypass group, though no statistically significant difference was observed. Conclusion: The present study findings demonstrated no statistically significant difference between these methods in regard with the safety aspect. As a result, selection as well as success of the bariatric surgery procedures depend on the patient's and surgeon's preferences.

  13. Gastritis in patients undergoing sleeve gastrectomy

    Science.gov (United States)

    Rath-Wolfson, Lea; Varona, Roy; Bubis, Golan; Tatarov, Alexander; Koren, Rumelia; Ram, Edward

    2017-01-01

    Abstract Laparoscopic sleeve gastrectomy (LSG) is a therapeutic option in severely obese patients. The aim of this study was to evaluate the presence of Helicobacter pylori (HP) gastritis and non-Helicobacter gastritis in the gastrectomy specimens, and its association to other variables. One hundred six sleeve gastrectomy specimens were examined histopathologically for the presence of gastritis and its relation to other factors like ethnicity, glycemic control, and postoperative complications. Twelve patients had HP gastritis, 39 had non-HP gastritis, and 55 had normal mucosa. There was a statistical difference between the Arab and Jewish Israeli patients in our study. Twenty-eight of the Arab patients had HP gastritis and 48% had non-HP gastritis. In the Jewish population 6% had HP gastritis and 34% had non-HP gastritis. The preoperative glycemic control was worse in the gastritis group with a mean HbA1c of 8.344% while in the normal mucosa group the mean HbA1c was 6.55. After operation the glycemic control reverted to normal in most the diabetic patients. There were few postoperative complications however, they were not related to HP. There is a high incidence of gastritis in obese patients. The incidence of gastritis in the Arab population in our study was higher than that in the Jewish population. The glycemic control before surgery was worse in patients with gastritis than in the normal mucosa group. HP bares no risk for postoperative complications after LSG and does not affect weight loss. However a larger cohort of patients must be studied to arrive at conclusive results. PMID:28422853

  14. Laparoscopic sleeve gastrectomy and gastroesophageal reflux

    Science.gov (United States)

    Stenard, Fabien; Iannelli, Antonio

    2015-01-01

    Bariatric surgery is the only effective procedure that provides long-term sustained weight loss. Sleeve gastrectomy (SG) has emerged over the last few years to be an ideal bariatric procedure because it has several advantages compared to more complex bariatric procedures, including avoiding an intestinal bypass. However, several published follow-up studies report an increased rate of gastroesophageal reflux (GERD) after a SG. GERD is described as either de novo or as being caused by aggravation of preexisting symptoms. However, the literature on this topic is ambivalent despite the potentially increased rate of GERDs that may occur after this common bariatric procedure. This article reviews the mechanisms responsible for GERD in obese subjects as well as the results after a SG with respect to GERD. Future directions for clinical research are discussed along with the current surgical options for morbidly obese patients with GERD and undergoing bariatric surgery. PMID:26420961

  15. Laparoscopic sleeve gastrectomy and gastroesophageal reflux.

    Science.gov (United States)

    Stenard, Fabien; Iannelli, Antonio

    2015-09-28

    Bariatric surgery is the only effective procedure that provides long-term sustained weight loss. Sleeve gastrectomy (SG) has emerged over the last few years to be an ideal bariatric procedure because it has several advantages compared to more complex bariatric procedures, including avoiding an intestinal bypass. However, several published follow-up studies report an increased rate of gastroesophageal reflux (GERD) after a SG. GERD is described as either de novo or as being caused by aggravation of preexisting symptoms. However, the literature on this topic is ambivalent despite the potentially increased rate of GERDs that may occur after this common bariatric procedure. This article reviews the mechanisms responsible for GERD in obese subjects as well as the results after a SG with respect to GERD. Future directions for clinical research are discussed along with the current surgical options for morbidly obese patients with GERD and undergoing bariatric surgery.

  16. Maintenance of Multivitamin Supplements After Sleeve Gastrectomy.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Llavero, Carolina; Zubiaga, Lorea; Boix, Evangelina

    2016-10-01

    After all bariatric procedures, multivitamin supplements are uniformly prescribed to minimize eventual deficiencies. These supplements are usually maintained long time, even during the whole life after malabsorptive techniques, while these are maintained at least during 1 year after restrictive procedures. Given that sleeve gastrectomy does not alter intestinal absorption, the supplements are possibly unnecessary, once the patient can take an adequate diet. A prospective randomized study of patients undergoing a laparoscopic sleeve gastrectomy was performed. Patients were randomized into two groups: those patients receiving the multivitamin supplement (Multicentrum, Pfizer, 1 tablet/day) during 3 months (group 1) and those receiving the supplement during 12 months (group 2). Laboratory data were recorded: vitamins (D, B12 and folic acid) and oligoelements (calcium, iron, phosphorus, magnesium and zinc) at 3, 6 and 12 months after surgery. Eighty patients were included, 40 in each group. At 3 months, 7.5 % of the patients presented iron deficiency and 2.5 % ferritin one, similarly in both groups, that was corrected with specific extra iron supplements. At 6 months, one patient (2.5 %) in group 1 presented iron deficiency and one in group 2 vitamin D deficiency (NS). At 12 months, only one patient in group 2 presented vitamin D deficiency, treated with specific supplements. The maintenance of multivitamin supplements more than 3 months postoperatively seems to be of no benefit. It is preferable monitoring laboratory values and adding specific supplements when necessary. CLINICALTRIALS. NCT02620137.

  17. Safety and short-term outcomes of laparoscopic sleeve gastrectomy as a revisional approach for failed laparoscopic adjustable gastric banding in the treatment of morbid obesity.

    Science.gov (United States)

    Acholonu, Emeka; McBean, Etwar; Court, Ismael; Bellorin, Omar; Szomstein, Samuel; Rosenthal, Raul J

    2009-12-01

    Laparoscopic sleeve gastrectomy (LSG) has been used as a first step of a two-stage approach in bariatric surgery for high-risk patients. Recently, LSG is being utilized as a primary and final procedure for morbid obesity with acceptable short-term results. The aim of this study is to investigate the effectiveness of LSG as a revisional procedure for patients with unsatisfactory outcomes after laparoscopic adjustable gastric band (LAGB). A retrospective review of a prospectively maintained database was performed. Data were reviewed for all patients undergoing revision from LAGB to LSG during the period May 2005 and May 2009. Data collected included demographics, indication for revision, operative time, length of stay, postoperative complications, and degree of weight reduction. Fifteen patients (three males and 12 females) had revisional surgery converting a LAGB to a LSG. The indication in four patients (26.66%) was weight regains and in five patients (33.33%) was poor weight loss; four patients (26.66%) had a band slippage and symptoms of gastroesophageal reflux, and one patient (6.66%) had poor weight loss, band slippage, and reflux. In one patient (6.66%), the indication was slippage and duodenal fistula. One-step revision procedure was done in 13 patients (86.66%), while two-step procedure was done in two patients (13.33%). Mean preoperative weight and BMI were 233.02 (181.4-300) lb and 38.66 (29.7-49.3) kg/m2, respectively. Mean weight loss at 2, 6, 12, 18, and 24 months postoperatively was 20.7, 48.3, 57.2, 60.1, and 13.5 lb, respectively. Mean % excess BMI loss was 28.9%, 64.2%, 65.3%, 65.7%, and 22.25% at 2, 6, 12, 18, and 24 months, respectively. There was one major complication (staple line leak) and one postoperative acute gastric outlet obstruction. We had no mortality. Thirteen patients were followed up postoperatively. The number decreased as follow-up time progressed. LSG could provide short-term weight loss after previously failed LABG, but prone to

  18. Psychological changes in morbidly obese patients after sleeve gastrectomy.

    Science.gov (United States)

    Melero, Yolanda; Ferrer, José Vicente; Sanahuja, Angel; Amador, Lydia; Hernando, Denise

    2014-01-01

    The aim of this study is to observe the psychological changes at one year postop in a group of patients undergoing laparoscopic vertical sleeve gastrectomy (GVL) and multidisciplinary follow- up. A total of 46 patients with a BMI-35 or higher, who were selected for GVL, completed psychological testing. After GVL surgery, patients received psychological, nutritional, and medical attention during 12 months, and they retook the same tests. Psychological tests showed an improvement on almost all scales tested, except perfectionism. The most significant change was in the benchmark for Eating Disorders with an improvement of 89% for bulimia (Pchange in health status (Ppsychological changes are similar to Roux-en-Y Gastric bypass but different to vertical banded gastroplasty or adjustable gastric band, according to previous studies. However, long-term studies are necessary to confirm this trend. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  19. Carbon dioxide embolism during laparoscopic sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Amir Abu Zikry

    2011-01-01

    Full Text Available Bariatric restrictive and malabsorptive operations are being carried out in most countries laparoscopically. Carbon dioxide or gas embolism has never been reported in obese patients undergoing bariatric surgery. We report a case of carbon dioxide embolism during laparoscopic sleeve gastrectomy (LSG in a young super obese female patient. Early diagnosis and successful management of this complication are discussed. An 18-year-old super obese female patient with enlarged fatty liver underwent LSG under general anesthesia. During initial intra-peritoneal insufflation with CO 2 at high flows through upper left quadrant of the abdomen, she had precipitous fall of end-tidal CO 2 and SaO 2 % accompanied with tachycardia. Early suspicion led to stoppage of further insufflation. Clinical parameters were stabilized after almost 30 min, while the blood gas analysis was restored to normal levels after 1 h. The area of gas entrainment on the damaged liver was recognized by the surgeon and sealed and the surgery was successfully carried out uneventfully. Like any other laparoscopic surgery, carbon dioxide embolism can occur during bariatric laparoscopic surgery also. Caution should be exercised when Veress needle is inserted through upper left quadrant of the abdomen in patients with enlarged liver. A high degree of suspicion and prompt collaboration between the surgeon and anesthetist can lead to complete recovery from this potentially fatal complication.

  20. Influence of Age on Sleeve Gastrectomy Results.

    Science.gov (United States)

    Pauleau, Ghislain; Goin, Géraldine; Goudard, Yvain; De La Villeon, Bruno; Brardjanian, Sarah; Balandraud, Paul

    2018-02-01

    Sleeve gastrectomy (SG) has been a booming technique for 10 years. Bariatric surgery in patients over 50 years can be an effective solution on weight loss and comorbidities. The association with the nutritional and psychological care is essential to allow a true change of life mode. We are studying the mid-term (3-year) outcomes after SG in patients over 50 years of age. This retrospective study analyzes patients treated between January 2011 and December 2013. The 129 patients were divided into three groups: under 35 years (n = 52), 35-50 years (n = 49), and over 50 years (n = 28). The excess weight loss at 3 years were 75% for the under 35 years, 82% for the 35-50 years, and 69% for the over 50 years. Follow-up compliance at 3 years was 66%, 68%, 75%, respectively. Comorbidities were improved in all three groups with no significant difference for each comorbidity. SG is an effective technique on weight and comorbidities. The results at 3 years are similar in patients over the age of 50 who seem more able to follow up and change lifestyle.

  1. Laparoscopic sleeve gastrectomy leads the U.S. utilization of bariatric surgery at academic medical centers.

    Science.gov (United States)

    Varela, J Esteban; Nguyen, Ninh T

    2015-01-01

    Analysis of a recent single state bariatric surgery registry revealed that laparoscopic sleeve gastrectomy was the most common bariatric procedure starting in 2012. The objective of this study was to examine the trend in utilization of laparoscopic sleeve gastrectomy performed at academic medical centers in the United States. Using ICD-9 diagnosis and procedure codes, clinical data obtained from the University HealthSystem Consortium database for all bariatric procedures performed for the treatment of severe obesity between October 1, 2011, and June 30, 2014. Quarterly trends in utilization for the 4 most commonly performed bariatric operations were examined, and comparisons between procedures were performed. A total of 54,953 bariatric procedures were performed. Utilization of laparoscopic sleeve gastrectomy increased from 23.7% of all bariatric procedures during the fourth quarter of 2011 to 60.7% during the second quarter of 2014 while laparoscopic gastric bypass decreased from 62.2% to 37.0%, respectively. Utilization of laparoscopic sleeve gastrectomy surpassed that of laparoscopic gastric bypass in the second quarter of 2013 (50.6% versus 45.8%). During the same time period, utilization of open gastric bypass fell from 6.6% to 1.5%, and the use of laparoscopic adjustable gastric banding decreased from 7.5% to .8%. Within the context of U.S. academic medical centers, there has been a significant increase in the utilization of laparoscopic sleeve gastrectomy, which has surpassed laparoscopic gastric bypass utilization since 2013. Laparoscopic sleeve gastrectomy is now the most commonly performed bariatric procedure at the national level within academic centers. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  2. Changes in the makeup of bariatric surgery: a national increase in use of laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Nguyen, Ninh T; Nguyen, Brian; Gebhart, Alana; Hohmann, Samuel

    2013-02-01

    Laparoscopic sleeve gastrectomy is gaining popularity in the US; however, there has been no study examining the use of sleeve gastrectomy at a national level and its impact on the use of other bariatric operations. The aim of this study was to examine contemporary changes in use and outcomes of bariatric surgery performed at academic medical centers. Using ICD-9 diagnosis and procedure codes, clinical data obtained from the University HealthSystem Consortium database for all bariatric procedures performed for the treatment of morbid obesity between October 1, 2008 and September 30, 2012 were reviewed. Quartile trends in use for the 3 most commonly performed bariatric operations were examined, and a comparison of perioperative outcomes between procedures was performed within a subset of patients with minor severity of illness. A total of 60,738 bariatric procedures were examined. In 2008, the makeup of bariatric surgery consisted primarily of gastric bypass (66.8% laparoscopic, 8.6% open), followed by laparoscopic gastric banding (23.8%). In 2012, there was a precipitous increase in use of laparoscopic sleeve gastrectomy (36.3 %), with a concurrent reduction in the use of laparoscopic (56.4%) and open (3.2%) gastric bypass, and a major reduction in laparoscopic gastric banding (4.1%). The length of hospital stay, in-hospital morbidity and mortality, and costs for laparoscopic sleeve gastrectomy were found to be between those of laparoscopic gastric banding and laparoscopic gastric bypass. Within the context of academic medical centers, there has been a recent change in the makeup of bariatric surgery. There has been an increase in the use of laparoscopic sleeve gastrectomy, which has had an impact primarily on reducing the use of laparoscopic adjustable gastric banding. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Esophageal motility after laparoscopic sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Sioka E

    2017-07-01

    Full Text Available Eleni Sioka,1 George Tzovaras,1 Fotios Tsiopoulos,2 Dimitris Papamargaritis,1 Spyros Potamianos,2 Constantine Chatzitheofilou,1 Dimitris Zacharoulis1 1Department of Surgery, 2Department of Gastroenterology, University Hospital of Larissa, University of Thessaly, Larissa, Greece Background: Laparoscopic sleeve gastrectomy (LSG modifies the upper gastrointestinal tract motility. Controversial data currently exist. The aim of the study was to evaluate esophageal motility before and after LSG.Patients and methods: Morbid obese patients scheduled for LSG underwent reflux symptoms evaluation and manometry preoperatively and postoperatively. The preoperative and postoperative results were compared and analyzed.Results: Eighteen patients were enrolled. Heartburn and regurgitation improved in 38.9% and 11.1% of the patients, but deteriorated in 11.1% and 27.8% of the patients, respectively. Lower esophageal sphincter (LES total length decreased postoperatively (p=0.002. Resting and residual pressures tended to decrease postoperatively (mean difference [95% confidence interval]: −4 [−8.3/0.2] mmHg, p=0.060; −1.4 [−3/0.1] mmHg, p=0.071, respectively. Amplitude pressure decreased from 95.7±37.3 to 69.8±26.3 mmHg at the upper border of LES (p=0.014, and tended to decrease at the distal esophagus from 128.5±30.1 to 112.1±35.4 mmHg (p=0.06 and mid-esophagus from 72.7±34.5 to 49.4±16.7 mmHg (p=0.006. Peristaltic normal swallow percentage increased from 47.2±36.8 to 82.8±28% (p=0.003. Postoperative regurgitation was strongly negatively correlated with LES total length (Spearman’s r=−0.670. When groups were compared according to heartburn status, statistical significance was observed between the groups of improvement and deterioration regarding postoperative residual pressure and postoperative relaxation (p<0.002, p<0.002, respectively. With regard to regurgitation status, there was statistically significant difference between groups regarding

  4. Rare Neurological Complications After Sleeve Gastrectomy.

    Science.gov (United States)

    Tabbara, Malek; Carandina, Sergio; Bossi, Manuela; Polliand, Claude; Genser, Laurent; Barrat, Christophe

    2016-12-01

    Bariatric surgery is considered to be the most effective treatment of morbid obesity and improvement of obesity-related comorbidities, such as type II diabetes. However, both peripheral and central neurological complications can occur after bariatric surgery. Such complications tend to occur more frequently after bypass surgery than after sleeve gastrectomy (SG). The objective of this study was to identify the patients that presented post-operative neurological complications after undergoing SG and describe the incidence, presentation, and management of these complications. This was a retrospective study of 592 cases of SG performed between 2009 and 2014 with a special focus on patients who presented neurological complications. Of the 592 SG cases, only seven (1.18 %) patients presented neurological complications. All patients had uneventful post-operative course, but all reported feeding difficulties, accompanied by severe dysphagia, and rapid weight loss, with a mean weight loss of 35 kg (30-40 kg) 3 months after SG. All patients were readmitted owing to neurological symptoms that included paresthesia, abolition of deep tendon reflexes of the lower limbs, muscle pain, and motor and sensitive deficits in some cases. There were two cases of Wernicke's encephalopathy. All patients were treated for neuropathy secondary to vitamin B1 deficiency and had a significant improvement and/or resolution of their symptoms. Neurological complications after SG are rare and are often preceded by gastrointestinal symptoms, rapid weight loss, and lack of post-operative vitamin supplementation. Re-hospitalization and multidisciplinary team management are crucial to establish the diagnosis and initiate treatment.

  5. Laparoscopic sleeve gastrectomy: more than a restrictive bariatric surgery procedure?

    OpenAIRE

    Benaiges Foix, David; Más-Lorenzo, Antonio; Goday Arno, Alberto; Ramón Moros, José Manuel; Chillarón Jordan, Juan José; Pedro-Botet, Juan Carlos; Flores-Le-Roux, Juana Antonia

    2015-01-01

    Sleeve gastrectomy (SG) is a restrictive bariatric surgery technique that was first used as part of restrictive horizontal gastrectomy in the original Scopinaro type biliopancreatic diversion. Its good results as a single technique have led to a rise in its use, and it is currently the second most performed technique worldwide. SG achieves clearly better results than other restrictive techniques and is comparable in some aspects to the Roux-en-Y gastric bypass, the current gold standard in ba...

  6. Management Options for Twisted Gastric Tube after Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Abd Ellatif, Mohamed E; Abbas, Ashraf; El Nakeeb, Ayman; Magdy, Alaa; Salama, Asaad F; Bashah, Moataz M; Dawoud, Ibrahim; Gamal, Maged Ali; Sargsyan, Davit

    2017-09-01

    This study aims to determine the incidence, etiology, and management options for symptomatic gastric obstruction caused by axially twisted sleeve gastrectomy. In this retrospective study, we reviewed medical charts of all morbidly obese patients who underwent laparoscopic sleeve gastrectomy. Patients who developed gastric obstruction symptoms and were diagnosed with twisted sleeve gastrectomy were identified and included in this study. From October 2005 to December 2015, there are 3634 morbidly obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Eighty-six (2.3%) patients developed symptoms of gastric obstruction. Forty-five (1.23%) patients were included in this study. The mean time of presentation was 59.8 days after surgery. Upper GI contrast study was done routinely, and it was positive for axial twist in 37 (82%) patients. Abdominal CT with oral and IV contrast was done in eight (18%) when swallow study was equivocal. Endoscopic treatment was successful in 43 patients (95.5%). Sixteen patients were successfully managed by endoscopic stenting, and 29 patients had balloon dilation. The average numbers of dilation sessions were 1.7. Out of these 29 patients, 18 responded well to a single session of dilatation and did not require any further dilatation sessions. Two patients who failed to respond to three subsequent sessions of balloon dilation underwent laparoscopic adhesiolysis and gastropexy. Endoscopic stenting is an effective tool in management of axial rotation of sleeved stomach. Balloon dilation can also be effective in selected cases. Few cases might require laparoscopic adhesiolysis and gastropexy.

  7. Thrombosis of the spleno-mesentiric portal axis following laparoscopic sleeve gastrectomy: A rare case report

    Directory of Open Access Journals (Sweden)

    Saleh Alshreadah

    Full Text Available Introduction: Mesenteric, splenic and portal veins thrombosis (MSPVT is uncommon complication after sleeve gastrectomy. Case report: A 38-year-old female underwent laparoscopic sleeve gastrectomy (LSG for the treatment of morbid obesity, presented 4 weeks later with epigastric pain. Computed tomography (CT scan revealed superior mesenteric, splenic and the portal veins thrombosis. Conclusion: MSPVT is a rare presentation after laparoscopic sleeve gastrectomy, which requires early diagnosis and management and it should be included in the differential diagnosis for unexplained abdominal symptoms after laparoscopic sleeve gastrectomy Keywords: Laparoscopic sleeve gastrectomy, Obesity, Portal vein thrombosis

  8. Association between postprandial symptoms and gastric emptying after sleeve gastrectomy

    NARCIS (Netherlands)

    Burgerhart, Jan S.; van Rutte, Pim W. J.; Edelbroek, Michela A. L.; Wyndaele, Dirk N. J.; Smulders, Johannes F.; van de Meeberg, Paul C.; Siersema, Peter D.; Smout, André J. P. M.

    2015-01-01

    Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure. However, postprandial symptoms can compromise its beneficial effect. It is not known if a changed gastric emptying and these symptoms are related. This study aimed to assess the association between postprandial symptoms and

  9. Hospital variation in perioperative complications for laparoscopic sleeve gastrectomy in Michigan.

    Science.gov (United States)

    Pradarelli, Jason C; Varban, Oliver A; Ghaferi, Amir A; Weiner, Matthew; Carlin, Arthur M; Dimick, Justin B

    2016-04-01

    Laparoscopic sleeve gastrectomy has surpassed gastric bypass and laparoscopic adjustable gastric banding recently as the most common weight-loss procedure. Previously, substantial concerns existed regarding variation in perioperative safety with bariatric surgery. This study aimed to assess rates of perioperative complications for laparoscopic sleeve gastrectomy across hospitals and in relation to procedure volume within the Michigan Bariatric Surgery Collaborative. We analyzed 8,693 patients who underwent laparoscopic sleeve gastrectomy from 2013 through 2014 across 40 hospitals in the Michigan Bariatric Surgery Collaborative. Mixed-effects logistic regression was used to assess hospital variation in risk- and reliability-adjusted rates of overall and serious 30-day complications and their relationship with hospital annual volume of stapling procedures (gastric bypass and sleeve gastrectomy). Overall, 5.4% of patients experienced perioperative complications. Adjusted rates of overall complications varied three-fold across hospitals, ranging from 3.6% (95% confidence interval 1.9-6.8%) to 11.0% (95% confidence interval 7.7-15.5%). Serious complications occurred in just 1.2% of patients and varied minimally. In this analysis, hospital volume was not associated with overall or serious complications. The 1 hospital with significantly less overall complication rates was high-volume (≥ 125 procedures/year); however, of the 4 hospitals with significantly greater complication rates, 3 were medium-volume (50-124 procedures/year), and 1 was high-volume. The remaining hospitals were not significantly different than the cohort mean. Serious complications among patients undergoing laparoscopic sleeve gastrectomy were relatively infrequent in this cohort of patients in the Michigan Bariatric Surgery Collaborative. Rates of overall complications varied widely across the hospitals enrolled in this statewide quality collaborative, although this variation was unrelated to volume

  10. Chronic Gastritis in Morbidly Obese Patients with Sleeve Gastrectomy

    OpenAIRE

    Makki, Ahmed Mohammad; Aldaqal, Saleh Mohammad; Alorabi, Shahad Hamadan; Nemri, Ismail Ahmed; Alajami, Maha Mohammad

    2016-01-01

    Introduction Obesity is a condition that has significant impact on public health. Recent exciting studies have linked chronic gastritis and H. pylori infection to obesity. Chronic gastritis has shown increased prevalence in obesity, more particularly H. pylori-related gastritis. This study aimed to determine the prevalence of chronic gastritis in morbidly obese patients who were subjected to sleeve gastrectomy, with focus on H. pylori-related gastritis. The aim was to demonstrate any influenc...

  11. Severe Insulin Resistance Improves Immediately After Sleeve Gastrectomy

    OpenAIRE

    Sharma, Rahul; Hassan, Chandra; Chaiban, Joumana T.

    2016-01-01

    Introduction. Obese individuals exhibit insulin resistance often leading to adverse health outcomes. When compared with intensive medical therapy, bariatric surgery has shown better outcomes mainly in terms of insulin resistance and glycemic control. Using the Homeostasis Model Assessment of insulin resistance (HOMA-IR), we report herein a case illustrating a drastic improvement in severe insulin resistance after sleeve gastrectomy in the immediate postoperative period. Case Report. A patient...

  12. Loss-of-Control Eating Following Sleeve Gastrectomy Surgery

    Science.gov (United States)

    Ivezaj, Valentina; Kessler, Erin E.; Lydecker, Janet A.; Barnes, Rachel D.; White, Marney A.; Grilo, Carlos M.

    2016-01-01

    Background Post-operative loss-of-control (LOC) eating is related to poorer weight loss outcomes following bariatric surgery, but little is known about LOC eating following sleeve gastrectomy surgery. Objectives To examine LOC eating severity and weight loss following sleeve gastrectomy. Setting University School of Medicine, U.S. Methods Participants were 71 individuals (84.5% female; n=60) who underwent sleeve gastrectomy surgery within the previous 4–9 months and reported LOC eating at least once weekly during the previous 28 days. LOC eating was assessed using the Eating Disorder Examination (EDE) Bariatric Surgery Version. Current mean age and body mass index were 47.3 (SD=10.1) years and 37.9 (SD=8.2) kg/m2. Two groups, bariatric binge-eating disorder (Bar-BED) and loss-of-control eating only (LOC-Only) were created based on modified binge-eating disorder (BED) criteria, which excluded the “unusually large quantity of food” criterion due to limited gastric capacity post-surgery. Bar-BED criteria mirrored BED criteria and consisted of the following: at least 12 LOC eating episodes over the prior three months (once weekly), 3 of 5 associated symptoms, marked distress over LOC eating, and lack of regular compensatory behaviors. Results Based on these revised criteria, 49.3% (n=35) were classified as the Bar-BED group and 50.7% (n=36) as the LOC-Only group. Compared to the LOC-Only group, the Bar-BED group had significantly greater EDE global and subscale scores and lower percent weight loss by six months post-surgery. Conclusions Findings suggest LOC eating that parallels BED post-surgery is associated with poorer outcomes following sleeve gastrectomy including poorer weight loss and greater severity of eating-disorder psychopathology. PMID:27913121

  13. Laparoscopic Sleeve Gastrectomy Improves Olfaction Sensitivity in Morbidly Obese Patients.

    Science.gov (United States)

    Hancı, Deniz; Altun, Huseyin; Altun, Hasan; Batman, Burcin; Karip, Aziz Bora; Serin, Kursat Rahmi

    2016-03-01

    Olfactory abilities of the patients are known to be altered by eating and metabolic disorders, including obesity. There are only a number of studies investigating the effect of obesity on olfaction, and there is limited data on the changes in olfactory abilities of morbidly obese patients after surgical treatment. Here we investigated the changes in olfactory abilities of 54 morbidly obese patients (M/F, 22/32; age range 19-57 years; body mass index (BMI) range 30.5-63.0 kg/m(2)) after laparoscopic sleeve gastrectomy. A laparoscopic sleeve gastrectomy was performed by the same surgeon using five-port technique. Olfactory abilities were tested preoperatively and 1, 3, and 6 months after the surgery using a standardized Sniffin' Sticks Extended Test kit. Analyses of variance indicated statistically significant improvement in T, D, and I scores of morbidly obese patients within time factors (preoperative vs. 1, 3, and 6 months; 1 vs. 3 and 6 months; and 3 vs. 6 months; p < 0.001 for all). There was a statistically significant improvement in overall TDI scores with an increase from 25 to 41 during the 6 months follow-up period (p < 0.001 for all). Here, for the first time in literature, we were able to show the significant improvement in olfactory abilities of morbidly obese patients after laparoscopic sleeve gastrectomy.

  14. Esophageal adenocarcinoma five years after laparoscopic sleeve gastrectomy. A case report

    Directory of Open Access Journals (Sweden)

    Fernando Gabriel Wright

    2017-01-01

    Conclusion: We present a case of an esophageal adenocarcinoma five years after a laparoscopic sleeve gastrectomy for morbid obesity. There is need to better determine the relationship between sleeve gastrectomy and gastroesophageal reflux disease in order to prevent its related complications, such as esophageal adenocarcinoma.

  15. Laparoscopic sleeve gastrectomy: More than a restrictive bariatric surgery procedure?

    Science.gov (United States)

    Benaiges, David; Más-Lorenzo, Antonio; Goday, Albert; Ramon, José M; Chillarón, Juan J; Pedro-Botet, Juan; Roux, Juana A Flores-Le

    2015-01-01

    Sleeve gastrectomy (SG) is a restrictive bariatric surgery technique that was first used as part of restrictive horizontal gastrectomy in the original Scopinaro type biliopancreatic diversion. Its good results as a single technique have led to a rise in its use, and it is currently the second most performed technique worldwide. SG achieves clearly better results than other restrictive techniques and is comparable in some aspects to the Roux-en-Y gastric bypass, the current gold standard in bariatric surgery. These benefits have been associated with different pathophysiologic mechanisms unrelated to weight loss such as increased gastric emptying and intestinal transit, and activation of hormonal mechanisms such as increased GLP-1 hormone and decreased ghrelin. The aim of this review was to highlight the salient aspects of SG regarding its historical evolution, pathophysiologic mechanisms, main results, clinical applications and perioperative complications. PMID:26557004

  16. Dietary intake and ghrelin and leptin changes after sleeve gastrectomy

    OpenAIRE

    Bu?ga, Marek; Zavadilov?, Vladislava; Hol?czy, Pavol; ?vagera, Zden?k; ?vorc, Pavol; Foltys, Ale?; Zon?a, Pavel

    2014-01-01

    Introduction Surgical intervention in obesity is today the most effective treatment method in high level obesity management. Bariatric interventions not only ensure body weight reduction, but may influence dietary habits. Aim To assess changes in adipose hormones and dietary habits in obese patients after sleeve gastrectomy. Material and methods The study set comprised 37 subjects (29 females and 8 males) 24 to 68 years old with body mass index 43.0 ?4.9 kg/m2. Pre-operative examination inclu...

  17. Duodenal-jejunal bypass with sleeve gastrectomy versus the sleeve gastrectomy procedure alone: the role of duodenal exclusion.

    Science.gov (United States)

    Lee, Wei-Jei; Almulaifi, Abdullah M; Tsou, Jun-Juin; Ser, Kong-Han; Lee, Yi-Chih; Chen, Shu-Chun

    2015-01-01

    Laparoscopic sleeve gastrectomy (SG) has become accepted as a stand-alone procedure as a less complex operation than laparoscopic duodenojejunal bypass with sleeve gastrectomy (DJB-SG). The aim of this study was to compare one-year results between DJB-SG and SG. University hospital. A total of 89 patients who received a DJB-SG surgery were matched with a group of SG that were equal in age, sex, and body mass index (BMI). Complication rates, weight loss, and remission of co-morbidities were evaluated after 12 months. The mean preoperative patient BMI in the DJB-SG and SG groups was similar. There were more patients with type 2 diabetes mellitus (T2DM) in the DJB-SG group than in the SG group. The mean operative time and length of hospital stay (LOS) were significantly longer in the DJB-SG group than in the SG group. At 12 months after surgery, the BMI was lower and excess weight loss higher in DJB-SG than SG. Remission of T2DM was greater in the DJB-SG group. Low-density lipoprotein, total cholesterol, and metabolic syndrome (MS) improved after operation in both groups. In this study DJB-SG was superior to SG in T2DM remission, triglyceride improvement, excess weight loss, and lower BMI at 1 year after surgery. Adding duodenal switch to sleeve gastrectomy increases the effect of diabetic control and MS resolution. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  18. Early Laparoscopic Sleeve Gastrectomy Outcomes in Terms of Weight Loss

    International Nuclear Information System (INIS)

    Siddiq, G.; Aziz, W.; Pervez, M. B.; Haider, M. I.; Hussain, S. V.; Khan, N.

    2016-01-01

    Objective: To investigate the outcomes of laparoscopic sleeve gastrectomy (LSG) in terms of weight loss. Study Design: Descriptive cohort study. Place and Duration of Study: Department of Surgery, Shifa International Hospital, Islamabad, from January 2009 to January 2015. Methodology: A total of 100 consecutive patients were included in the study through retrospective chart review. A 5-port technique was utilized with the gastric sleeve being created using endostapler. Postoperatively, patients gradually progressed from clear liquid diet and oral rehydration salts to nutritional supplements over three days. By two weeks postoperatively, patients had progressed to a solid diet. SPSS was used for data entry and analysis. Body mass index (BMI) and weight in kg were determined. Results: From 100 patients, 17 were lost to follow-up less than a week into the postoperative period. Of the remaining, average age of the patients was 34.7 ±11.3 years at the time of surgery. The majority of patients were females (72 percentage). Mean preoperative and postoperative BMI was 45.3 ±10.4 kg/m2 and 35.0 ±10 kg/m2, respectively. Of the 83 patients, 62 were followed-up for longer than 1 month (average 419 days). For patients in this category, mean reduction in BMI was 10.3 ±6.5 kg/m2 with average weight loss of 34.3 ±18.2 kg. There were no mortalities associated with LSG. Conclusion: Laparoscopic sleeve gastrectomy is a safe and effective intervention in young Pakistani females with encouraging outcomes at a mean follow-up of over one year. (author)

  19. Energy Adaptations Persist 2 Years After Sleeve Gastrectomy and Gastric Bypass.

    Science.gov (United States)

    Tam, Charmaine S; Rigas, Georgia; Heilbronn, Leonie K; Matisan, Tania; Probst, Yasmine; Talbot, Michael

    2016-02-01

    Non-surgical weight loss induces a greater than expected decrease in energy expenditure, a phenomenon known as 'metabolic adaptation'. The effects of different bariatric surgery procedures on metabolic adaptation are not yet known and may partially contribute to weight loss success. We compared resting energy expenditure (REE) in 35 subjects (nine males; age = 46 ± 11 years; BMI = 42.1 ± 6.5 kg/m(2)) undergoing gastric band, sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) up to 2 years after surgery. We found a greater than expected reduction of 130-300 kcal/day at 6 weeks after sleeve and bypass surgery which was not explained by changes in body composition; this change was not seen in the band group. The suppression in REE after sleeve and RYGB remained up to 2 years, even after weight loss had plateaued. Our findings suggest that energy adaptation is not a contributing mechanism to medium-term weight maintenance after sleeve and RYGB bariatric surgeries.

  20. The bariatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults.

    Science.gov (United States)

    Golzarand, Mahdieh; Toolabi, Karamollah; Farid, Roya

    2017-11-01

    Several studies have been investigated to find the long-term effect of bariatric surgery on weight loss; nevertheless, a meta-analysis can detailedly demonstrate the effect of bariatric surgery on weight in morbidly obese patients. This study aimed to assess the long- and very long-term effects of laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) on weight loss in adults. An electronic search using PubMed, Scopus, and Google scholar databases was performed for all English-language articles up to May 15, 2016 with no publication date restriction. Outcome was long-term (≥5-10 years) and very long-term (≥10 years) weight reduction that reported as the mean %EWL and changes in BMI from baseline. Eighty articles with 87 arms were included in this meta-analysis. The excess weight loss percentage (%EWL) was 47.94% and 47.43% after LAGB at ≥5 and ≥10 years, respectively. After LRYGB the %EWL was 62.58% at ≥5 years and 63.52% at ≥10 years. It was 53.25% at ≥5 years after LSG. Results of subgroup analyses have indicated that LRYGB leads to higher %EWL in America and Asia compared with Europe. Meta-regression analyses have shown that there is no significant association between %EWL and baseline age, BMI and length of follow-up after three procedures. However, there is a positive association between gender and %EWL after LRYGB (β = 1.24). No publication bias was found. These findings suggest that LRYGB is an effective procedure in morbidly obese patients that leads to sustainable weight loss over the long- and very long-term periods in compared with LAGB and LSG.

  1. De novo gastric adenocarcinoma 1 year after sleeve gastrectomy in a transplant patient

    Directory of Open Access Journals (Sweden)

    M. Masrur

    2016-01-01

    Conclusions: No direct relation has been established between sleeve gastrectomy and the development of gastric cancer. Robotic procedures allow for complex multiorgan resections, while preserving the benefits of minimally invasive surgery.

  2. A gastroplastia em manga (sleeve gastrectomy e o diabetes mellitus Sleeve gastrectomy and diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Alexandre Ciro Andriani

    2008-09-01

    Full Text Available RACIONAL: O tipo 2 da diabete mellitus é muito frequente entre os pacientes de obesidade morbida. Ja foi provado cientificamente que o bypass gástrico pode curá-lo. Existem poucos relatos de que a gastroplastia em manga apresenta resultado promissores na cura desta forma de diabete. OBJETIVO: Apresentar resultados da glicemia em pacientes operados com a gastroplastia em manga mostrando sua possibilidade de controlar o dibetes. MÉTODO: Um estudo prospectivo envolvendo 15 pacientes foi realizado nos quais as dosagens sericas da glicose foram medidas no pré e pós-operatório. Para que houvesse homogeneidade da amostra, critérios de inclusão e exclusão foram estabelecidos com base nos pacientes com IMC de 35 a 40. Todos os pacientes foram submetidos a técnica cirurgica de gastroplastia em manga. O seguimento se deu em atendimento ambulatorial. RESULTADOS: Todos os pacientes foram operados pela técnica referida e seus níveis glicêmicos computados no pré, pós-operatório e no seguimento. CONCLUSÃO: A gastroplastia em manga cura o diabetes mellitus mostrando queda logo após a operação e mantendo-a ao longo do seguimento.BACKGROUND: The type 2 diabetes mellitus is very frequent among morbid obese patients. It has already been proven that the gastric bypass surgery may cures diabetes mellitus. There are few related studies to sleeve gastroplasty and diabetes. However, promising results exist. AIM: To analyse the glicemic results in patients submmitted to sleeve gastroplasty. METHODS: A 11 months prospective study on 15 patients was dome measuring their glycemic levels pre and postoperatively. The basic inclusion criteria was body mass index (BMI between 35 and 40 kg/m². All patients were operated by sleeve gastroplasty. RESULTS: All 15 patients lowered their glycemic level on their imidiate postoperative period and some achieved normal levels. CONCLUSIONS: The sleeve gastroplasty cures diabetes by lowering the plasma glucose and have

  3. Endoluminal stenting for the management of leak following sleeve gastrectomy and loop duodenojejunal bypass with sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Ying-Nan Tsai

    2018-01-01

    Full Text Available Postoperative leak is a serious complication of bariatric surgery and often results in significant morbidity and mortality. Stent placement is a less invasive alternative to surgery for the treatment of bariatric surgical leak. We evaluated the efficacy and complications of covered self-expandable metal stents (SEMS in the treatment of post-bariatric surgical leak. We retrospectively reviewed patients who underwent stent placement for leak after bariatric surgery. Leak was diagnosed by upper gastrointestinal series or was visualized during the endoscopy. We examined the timing of stent placement, size of the leak, stent migration and its complications, total stent treatment duration, and treatment outcome. Between January 2011 and April 2015, seven patients underwent covered SEMS placement for leak after bariatric surgery, including laparoscopic sleeve gastrectomy (LSG (n = 5 and laparoscopic loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG (n = 2. A stent was placed in one patient for infection control and bridging to revisional surgery. Among the other six patients, one patient who received stent placement one year after leak diagnosis failed to achieve leak closure, and five patients with early stent placement achieved leak closure. Three patients with small leak achieved leak closure more quickly. Stent migration was found in six patients, and associated ulcers occurred in five patients. We conclude that stenting is effective in the management of staple-line leaks following LSG and LDJB-SG. Stent migration and associated ulcers are common after stent placement. Early stent removal can be achieved in patients with small leaks.

  4. Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass--indications and outcome.

    Science.gov (United States)

    Langer, Felix B; Bohdjalian, Arthur; Shakeri-Leidenmühler, Soheila; Schoppmann, Sebastian F; Zacherl, Johannes; Prager, Gerhard

    2010-07-01

    Due to excellent weight loss success in the short-time follow-up, sleeve gastrectomy (SG) has gained popularity as sole and definitive bariatric procedure. In the long-term follow-up, weight loss failure and intractable severe reflux can necessitate further surgical intervention. A retrospective analysis of laparoscopic conversions from SG to Roux-en-Y gastric bypass (RYGB) was performed to assess the efficacy for reflux relief and weight loss success. A total of eight out of 73 patients (11%) underwent conversion to RYGB for severe reflux (n=3) or weight regain (n=5) after a median interval of 33 months following laparoscopic sleeve gastrectomy. In one of the patients, a banded gastric bypass was performed. In both groups, conversion to RYGB was successful, as proton pump inhibitor medication could be discontinued in all patients presenting with severe reflux, and a significant weight loss could be achieved in the patients with weight regain within a median follow-up of 33 months. Postoperative complications were observed in only one patient as leakage at the gastrojejunostomy was successfully treated by temporary stent placement. Conversion to RYGB is an effective treatment for weight regain or intractable reflux symptoms following SG. Thus, SG can be performed, intended as sole and definitive bariatric intervention, with conversion from SG to RYGB as an exit strategy for these complications.

  5. Food Tolerance and Quality of Alimentation Following Laparoscopic Sleeve Gastrectomy Calibrated with a 50-Fr Bougie: Long-Term Results.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Bozhychko, Maryana; Del-Campo, Jone Miren; Zubiaga, Lorea; Llavero, Carolina

    2018-04-02

    Adjustable gastric banding and vertical banded gastroplasty are associated with the worst postoperative food tolerance of all bariatric techniques. However, food tolerance tends to improve over time. The aim of this study was to assess food tolerance and diet quality in patients undergoing a sleeve gastrectomy, 1 and 5 years after surgery. A prospective observational study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy was performed. Food tolerance was assessed using the Quality of Alimentation questionnaire validated in bariatric patients. Ninety-three patients were analyzed. One year after surgery, mean excess weight loss (EWL) was 81.1% ± 8.3%, and 5 years after surgery, mean EWL was 79.9% ± 6.4%. Preoperatively, 39.8% of patients perceived their eating patterns as good or excellent, 1 year after surgery, 79.6% and 5 years postoperatively, 86%. One year after surgery, the patients reported some difficulty in tolerance of rice, pasta, and red meat. Five years after surgery, these difficulties disappeared and very few patients just refer some tolerance difficulties with red meat. One year after surgery, 10% of the patients reported that they suffered postprandial vomiting often and 22% rarely. Five years postoperatively, only 8% of subjects describe rarely vomiting. After sleeve gastrectomy, the patients recognize an improvement in the quality of alimentation. During the first postoperative year, they present tolerance problems with rice, pasta, and red meat, and that disappeared 5 years after surgery.

  6. Approach to Poor Weight Loss After Laparoscopic Sleeve Gastrectomy: Re-sleeve Vs. Gastric Bypass.

    Science.gov (United States)

    AlSabah, Salman; Alsharqawi, Nourah; Almulla, Ahmed; Akrof, Shehab; Alenezi, Khaled; Buhaimed, Waleed; Al-Subaie, Saud; Al Haddad, Mohanned

    2016-10-01

    Laparoscopic sleeve gastrectomy (LSG) is increasing worldwide; however, long-term follow-up results included insufficient weight loss and weight regain. This study aims at assessing the outcomes of converting LSG to laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic re-sleeve gastrectomy (LRSG). A total of 1300 patients underwent LSG from 2009 to 2012, of which 12 patients underwent LRYGB and 24 patients underwent LRSG in Al-Amiri Hospital alone. Data included length of stay, percentage excessive weight loss (EWL%), and body mass index (BMI). Twenty-four patients underwent conversion from LSG to LRSG, and 12 patients underwent conversion from LSG to LRYGB due to insufficient weight loss and weight regain. Eighty-five percent were females. The mean weight and BMI prior to LSG for the LRYGB and LRSG patients were 136.5 kg and 52, and 134 kg and 50, respectively. The EWL% after the initial LSG was 37.9 and 43 %, for LRYGB and LRSG, respectively. There were no complications recorded. Results of conversion of LSG to LRYGB involved a mean EWL% 61.3 % after 1 year (p value 0.009). Results of LRSG involved a mean EWL% of 57 % over interval of 1 year (p value 0.05). Comparison of the EWL% of LRYGB and LRSG for failed primary LSG was not significant (p value 0.097). Following our algorithm, revising an LSG with an LRSG or LRYGB for poor weight loss is feasible with good outcomes. Larger and longer follow-up studies are needed to verify our results.

  7. Dietary intake and ghrelin and leptin changes after sleeve gastrectomy.

    Science.gov (United States)

    Bužga, Marek; Zavadilová, Vladislava; Holéczy, Pavol; Švagera, Zdeněk; Švorc, Pavol; Foltys, Aleš; Zonča, Pavel

    2014-12-01

    Surgical intervention in obesity is today the most effective treatment method in high level obesity management. Bariatric interventions not only ensure body weight reduction, but may influence dietary habits. To assess changes in adipose hormones and dietary habits in obese patients after sleeve gastrectomy. The study set comprised 37 subjects (29 females and 8 males) 24 to 68 years old with body mass index 43.0 ±4.9 kg/m(2). Pre-operative examination included baseline measurements of body composition. Dietary habits and intake frequency were monitored by a questionnaire method. Follow-up examinations were carried out in a scope identical to the pre-operative examination, 6 and 12 months after surgery, respectively. The average patient weight loss 12 months after surgery was 31.7 kg. Excess weight loss was 55.2 ±20.6%. Patients reported reduced appetite (p meal portions per day (p = 0.003) and a decrease in consuming the largest portions during the afternoon and evening (p = 0.030). Plasma levels of fasting glucose, leptin and ghrelin significantly decreased (p = 0.006; p = 0.0.043); in contrast, the level of adiponectin significantly increased (p weight reduction within 1 year after surgery. An improvement of certain dietary habits in patients was registered. At 12 months after surgery, there were no statistically significant differences in decreases in ghrelin and leptin concentrations between patients without changed appetite and those reporting decreased appetite.

  8. Nutritional deficiencies after sleeve gastrectomy: can they be predicted preoperatively?

    Science.gov (United States)

    Ben-Porat, Tair; Elazary, Ram; Yuval, Jonathan B; Wieder, Ariela; Khalaileh, Abed; Weiss, Ram

    2015-01-01

    Nutritional deficiencies are common among morbidly obese patients. Data are scarce for patients who have undergone laparoscopic sleeve gastrectomy (LSG). The aim of the study is to clarify the prevalence of deficiencies and to identify risk factors for postoperative deficiencies. Hebrew University, Israel. Preoperative and 1-year postoperative data were collected. We included anthropometric parameters, obesity-related co-morbidities, and laboratory findings. There were 192 candidates. Seventy-seven of them completed follow-ups at 12 months. Before surgery, 15% had anemia. Deficiencies of iron, folate, and B12 were 47%, 32%, and 13%, respectively. Women were more deficient in iron (56% women, 26% men, Psurgery, low levels of vitamin D and elevated parathyroid hormone (PTH) were 99% and 41%, respectively. One year postsurgery, the deficiencies of hemoglobin and vitamin B12 worsened (20% and 17%, Pdeficiencies of iron, folate, vitamin D, and PTH improved (28%, 21%, 94%, and 10%, respectively). Deficiencies of hemoglobin, folate, and B12 before surgery were predictors for deficiencies 1 year after surgery (P = .006 OR = .090; P = .012 OR = .069; P = .062 OR = .165, respectively). LSG had a modest effect on nutritional deficiencies in our patients at 1-year postsurgery. Focusing on the preoperative nutritional status and tailoring a specific supplemental program for each individual should prevent postoperative deficiencies. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  9. Complications, Reoperations, and Nutrient Deficiencies Two Years after Sleeve Gastrectomy

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    Nicole Pech

    2012-01-01

    Full Text Available Background. The aim of this study was to investigate patient outcomes and nutritional deficiencies following sleeve gastrectomy (SG during a follow-up of two years. Methods. Over a period of 56 months, all consecutive patients who underwent SG were documented in this prospective, single-center, observational study. The study endpoints included operative time, complication rates, nutritional deficiencies and percentage of excess weight loss (%EWL. Results. From September 26, 2005 to May 28, 2009, 82 patients (female : male = 48 : 34 with a mean age of 43.3 years (range: 22–64 and a preoperative BMI of 52.5 kg/m² (range: 36.8–77.0 underwent SG. Major complications were observed in 9.8% of the patients, with 1 death. During follow up 51.2% of patients were supplemented with iron, 36.6% with zinc, 37.8% with calcium, 26.8% with vitamin D, 46.3% with vitamin B12 and 41.5% with folic acid. %EWL was 54.3, 65.3 and 62.6% after 6, 12 and 24 months. Conclusion. SG as a single step procedure is an effective bariatric intervention. Nutritional deficiencies after SG can be detected by routine nutritional screening. Our results show that Vitamin B12 supplementation should suggest routinely after SG.

  10. Splanchnic Vein Thrombosis - an Uncommon Complication after Laparoscopic Sleeve Gastrectomy

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    Tanja Carli

    2016-04-01

    Full Text Available Background: Laparoscopic sleeve gastrectomy (LSG is an innovative and relatively safe surgical approach for weight reduction in morbidly obese people. Splanchnic vein thrombosis (SVT is an extremely rare complication of LSG and, if not recognized, carries a high mortality rate. This paper highlights a potentially lethal condition of SVT after LSG. Case Report: A 37-year-old morbidly obese woman was referred to our institution for LSG. Three weeks after the intervention, she was readmitted with abdominal pain, vomiting, nausea, diarrhea, and fever with positive family anamnesis to viral disease. Abdominal X-ray as well as utrasonography were both normal, and no X-ray contrast medium leakage was observed. One week later, she was readmitted with septic condition. An abdominal computed tomography scan diagnosed lienal vein thrombosis along its whole length and partial thrombosis of the superior mesenteric vein. Conclusion: SVT presents very heterogeneously, which makes it extremely challenging to diagnose and to make an appropriate treatment decision. With regard to the high prevalence of obesity and the increasing frequency of LSG, prompt diagnosis and management are crucial.

  11. GERD and acid reduction medication use following gastric bypass and sleeve gastrectomy.

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    Barr, Alex C; Frelich, Matthew J; Bosler, Matthew E; Goldblatt, Matthew I; Gould, Jon C

    2017-01-01

    Gastroesophageal reflux disease is a common comorbid medical condition of obesity. Laparoscopic sleeve gastrectomy has been associated with de novo and worsening GERD following surgery. For this reason, patients who suffer from GERD and are considering bariatric surgery are often counseled to undergo gastric bypass. Given this practice, we sought to determine acid reduction medication (ARM) utilization in bariatric surgical patients who undergo one of these procedures prior to surgery and at 1 year following surgery. A retrospective review of prospectively maintained data on patients to undergo gastric bypass or sleeve gastrectomy between November 2012 and December 2014 was conducted after IRB approval. ARM utilization and Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) scores [range 0 (no symptoms)-50 (severe GERD)] were compared prior to surgery and at 1 year postoperatively. 334 patients underwent an eligible procedure in the study interval. 147 patients (44 %) had data on both preoperative and 1 year postoperative ARM use (93 gastric bypass and 54 sleeve gastrectomy). ARM utilization prior to surgery in gastric bypass patients did not reach statistical significance when compared to sleeve gastrectomy (40.9 vs. 26 %, p = 0.07). GERD-HRQL scores were greater prior to surgery in gastric bypass patients (GERD-HRQL 8.2 vs. 1.9; p sleeve gastrectomy patients had a significantly higher rate of overall ARM use (48.1 vs. 16.1 %, p gastric bypass patients. GERD-HRQL scores were similar overall at 12 months postoperatively (4.4 bypass vs. 4.8 sleeve; p = 0.72). Laparoscopic sleeve gastrectomy is associated with a significantly increased likelihood that acid reduction medications will be necessary for GERD symptom control 12 months postoperatively when compared to gastric bypass.

  12. Five-year results of laparoscopic sleeve gastrectomy for the treatment of severe obesity.

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    Nocca, David; Loureiro, Marcelo; Skalli, El Mehdi; Nedelcu, Marius; Jaussent, Audrey; Deloze, Melanie; Lefebvre, Patrick; Fabre, Jean Michel

    2017-08-01

    Since 2011, the most used bariatric technique in France has been the sleeve gastrectomy. There are still few studies exploring the medium and long-term results of this technique. To describe medium-long-term (5 years) results of a cohort of CHU Montpellier experience in sleeve gastrectomy for morbid obesity. All patients that underwent laparoscopic sleeve gastrectomy (LSG) from January 2005 to June 2013 were included in this study. A total of 1050 patients were operated. 72.86% were women. The mean preoperative BMI was 44.58 kg/m 2 (±7.71). A total of 183 patients (18.5%) were super-obese (BMI > 50 kg/m 2 ). LSG was proposed as primary procedure, and also after failure of adjustable gastric banding in 169 patients (16.9%) or after vertical banded gastroplasty in 7 cases (0.7%). There were 38 postoperative gastric fistulas (3.8%) and 3 of them required some kind of bypass to be definitively treated. There were also 34 hemorrhages (3.4%) of which 21 were reoperated for hemostasis. Two gastric stenoses at the angulus (0.2%) were managed with dilation or RYGB. Overall reoperative rate was 6.8%. One patient died of pulmonary embolism. Most common late complication was GERD (39.1%). After 3, 4 and 5 years of LSG, the average of %EBL was, respectively, 75.95% (±29.16) (382 patients), 73.23% (±31.08) (222 patients) and 69.26% (±30.86) (144 patients). The success rate at 5 years was 65.97% (95 patients). The improvement or remission of comorbidities was found, respectively, in 88.4 and 57.2% of diabetic patients; 76.9 and 19.2% for hypertensive patients and 98 and 85% for patients with sleep apnea syndrome. LSG is a bariatric surgery technique that presents a very good risk/benefit ratio. Five-year results are very convincing. GERD is the main long-term complication.

  13. Alcohol consumption after laparoscopic sleeve gastrectomy: 1-year results.

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    Coluzzi, Ilenia; Iossa, Angelo; Spinetti, Elena; Silecchia, Gianfranco

    2018-02-06

    Laparoscopic sleeve gastrectomy (SG) represents, at present, the most performed bariatric procedure worldwide with excellent long-term results on weight loss and comorbidities control. After the gastrectomy procedure, together with hormonal modification, several changes in taste and habits occur, including the potential modification in alcohol consumption. The aim of this prospective study was to determine the frequency and the amount of alcohol use before and after SG using a modified version of the Alcohol Use Disorder Identification Test (AUDIT) at 1-year follow-up and eventually to evaluate relationships between different ages and sexes. A total of 142 patients were prospectively enrolled and evaluated before and 1 year after SG with a modified AUDIT. The exclusion criteria were as follows: history of alcohol abuse, presence of psychopathology or cognitive impairments, diabetes mellitus type II decompensated, or previous gastrointestinal, liver, and pancreatic resective surgery. Subgroup analyses were performed between male and female and between under and over 40 years old. The median AUDIT score decreased from 2.70 (range 1-18) before surgery to 1.38 (range 1-7) after 1 year of SG, indicating a marked reduction in alcohol use. The most consumed alcoholic drink was beer (36.6%/n = 52) while after surgery the consumption of beer decreased considerably (21.1%/n = 30). The frequency of alcohol consumption also decreased: at baseline 45% of patients consumed alcoholic drinks "from 2 to 4 times per month", whereas 26 and 39.4% consumed alcohol "never" and "less than once a month," respectively. After surgery, nobody consumed more then six alcoholic drinks. No differences were found between the subgroups in terms of alcohol consumption and social behavior. The alcohol preference is modified and decreased 1 year after SG and this could be related to the strict nutritional follow-up and to the hormonal changes. Studies with large samples and long

  14. Robot-assisted sleeve gastrectomy in morbidly obese versus super obese patients.

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    Bhatia, Parveen; Bindal, Vivek; Singh, Rahul; Gonzalez-Heredia, Raquel; Kalhan, Sudhir; Khetan, Mukund; John, Suviraj

    2014-01-01

    This study evaluates our technique for robot-assisted sleeve gastrectomy for morbidly obese and super obese patients and our outcomes. A retrospective analysis of patients who underwent robot-assisted sleeve gastrectomy at a single center was performed. The procedure was performed with the da Vinci Si HD Surgical System (Intuitive Surgical, Sunnyvale, California). The staple line was imbricated with No. 2-0 polydioxanone in all cases. The super obese (body mass index≥50 kg/m2) subset of patients was compared with the morbidly obese group in terms of demographic characteristics, comorbidities, operative times, perioperative complications, and excess body weight loss. A total of 35 patients (15 female and 20 male patients) with a mean body mass index of 48.17±11.7 kg/m2 underwent robot-assisted sleeve gastrectomy. Of these patients, 11 were super obese and 24 were morbidly obese. The mean operative time was 116.3±24.7 minutes, and the mean docking time was 8.9±5.4 minutes. Mean blood loss was 19.36±4.62 mL, and there were no complications, conversions, or perioperative deaths. When compared with the morbidly obese patients, the super obese patients showed no significant difference in operative time, blood loss, and length of hospital stay. There was a steep decline in operating room times after 10 cases of robot-assisted sleeve gastrectomy. This study shows the feasibility and safety of robot-assisted sleeve gastrectomy. Robotic assistance might help overcome the operative difficulties encountered in super obese patients. It shows a rapid reduction in operative times with the growing experience of the entire operative team. Robot-assisted sleeve gastrectomy can be a good procedure by which to introduce robotics in a bariatric surgery center before going on to perform Roux-en-Y gastric bypass and revision procedures.

  15. Nutritional Status Prior to Laparoscopic Sleeve Gastrectomy Surgery.

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    Dagan, Shiri Sherf; Zelber-Sagi, Shira; Webb, Muriel; Keidar, Andrei; Raziel, Asnat; Sakran, Nasser; Goitein, David; Shibolet, Oren

    2016-09-01

    Two main causes for nutrient deficiencies following bariatric surgery (BS) are pre-operative deficiencies and favoring foods with high-energy density and poor micronutrient content. The aims of this study were to evaluate nutritional status and gender differences and the prevalence of nutritional deficiencies among candidates for laparoscopic sleeve gastrectomy (LSG) surgery. A cross-sectional analysis of pre-surgery data collected as part of a randomized clinical trial on 100 morbidly obese patients with non-alcoholic fatty liver disease (NAFLD) admitted to LSG surgery at Assuta Medical Center between February 2014 and January 2015. Anthropometrics, food intake, and fasting blood tests were evaluated during the baseline visit. One-hundred patients completed the pre-operative measurements (60 % female) with a mean age of 41.9 ± 9.8 years and a mean BMI of 42.3 ± 4.7 kg/m(2). Pre-operatively, deficiencies for iron, ferritin, folic acid, vitamin B1, vitamin B12, vitamin D, and hemoglobin were 6, 1, 1, 6, 0, 22, and 6 %, respectively. Pre-surgery, mean energy, protein, fat, and carbohydrate intake were 2710.7 ± 1275.7 kcal/day, 114.2 ± 48.5, 110.6 ± 54.5, and 321.6 ± 176.1 gr/day, respectively. The intakes for iron, calcium, folic acid, vitamin B12, and vitamin B1 were below the Dietary Reference Intake (DRI) recommendations for 46, 48, 58, 14, and 34 % of the study population, respectively. We found a low prevalence of nutritional deficiencies pre-operatively except for vitamin D. Most micronutrient intake did not reach the DRI recommendations, despite high-caloric and macronutrient intake indicating a poor dietary quality.

  16. Poor Health Behaviors Prior to Laparoscopic Sleeve Gastrectomy Surgery.

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    Oved, Irit; Vaiman, Inbal Markovitz; Hod, Keren; Mardy-Tilbor, Limor; Torban, Yakov; Dagan, Shiri Sherf

    2017-02-01

    Identifying eating and lifestyle behaviors prior to bariatric surgery may assist in better selecting and preparing patients and might lead to improved success rate. The current study aimed to assess eating behaviors and lifestyle trends among laparoscopic sleeve gastrectomy (LSG) candidates and to compare those trends between genders. This descriptive study was conducted in the bariatric clinic at the Haifa Assuta Medical Center. Data was gathered from medical records of LSG candidates that were evaluated before surgery in our institution between 2008 and 2011. The data included demographics, comorbidities, anthropometrics, weight management history, and lifestyle parameters. Eating pattern and eating habits were determined by eating habits questionnaires. A total of 266 LSG surgery candidates (71.4 % female) with an average age of 40.7 ± 10.9 years and pre-surgery BMI of 42.4 ± 4.8 kg/m 2 were studied. More than half of the patients have family history of obesity and their onset of obesity was before the age of 18 years (54.5 and 57.9 %, respectively). Most of the patients reported on poor eating habits and sedentary lifestyle: 65.1 % do not eat regular meals, 70.3 % skip over breakfast, 61.9 % presented loss of control eating, 45 % frequently consume sweets, and 80.1 % were classified as none active. There were no differences in eating patterns or lifestyle parameters between genders. High occurrence of unhealthy eating habits and a non-active lifestyle were detected in morbid obese candidates for LSG surgery. More efforts should be directed towards nutritional and lifestyle education prior to the surgery.

  17. Complications and nutrient deficiencies two years after sleeve gastrectomy

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    Pech Nicole

    2012-07-01

    Full Text Available Abstract Background The aim of this systematic study was to investigate patient outcomes and nutritional deficiencies following sleeve gastrectomy (SG during a median follow-up of two years. Methods Over a period of 56 months, all consecutive patients who underwent SG were documented in this prospective, single-center, observational study. The study endpoints included complication rates, nutritional deficiencies and percentage of excess weight loss (%EWL. Results From September 26, 2005 to May 28, 2009, 100 patients (female: male = 59:41 with a mean age of 43.6 years (range: 22–64 and a preoperative BMI of 52.3 kg/² (range: 36–77 underwent SG. The mean operative time was 86.4 min (range: 35–275. Major complications were observed in 8.0 % of the patients. During the follow-up period, 25 patients (25.0 % underwent a second bariatric intervention (22 DS and 3 RYGBP. Out of the total 100 patients, 48 % were supplemented with iron, 33 % with zinc, 34 % with a combination of calcium carbonate and cholecalciferol, 24 % with vitamin D, 42 % with vitamin B12 and 40 % with folic acid. The patients who received only a SG (n = 75 had %EWL of 53.6, 65.8 and 62.6 % after 6, 12 and 24 months, respectively. Conclusions SG is a highly effective bariatric intervention for morbidly obese patients. Nutritional deficiencies resulting from the procedure can be detected by routine nutritional screening. Results of the study show that Vitamin B12 supplementation should suggested routinely.

  18. The Impact of Sleeve Gastrectomy on Hyperlipidemia: A Systematic Review

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    Khalid Al Khalifa

    2013-01-01

    Full Text Available Background. Weight loss and reduction in comorbidities can be achieved by longitudinal sleeve gastrectomy (LSG. Existing evidence suggests that LSG resolves or improves hyperlipidemia in morbidly obese patients. The aim of this study was to systematically review the effect of LSG on hyperlipidemia. Methods. A systematic literature search was conducted from English-language studies published from 2000 to 2012 for the following databases: MEDLINE, EMBASE, CINAHL, PubMed, Clinical evidence, Scopus, Dara, Web of Sciences, TRIP, Health Technology Database, Cochrane library, and PsycINFO. Results. A total of 4,211 articles were identified in the initial search, and 4,185 articles were excluded based on the exclusion criteria. Twenty-six studies met the inclusion criteria for this systematic review, involving 3,591 patients. The mean preoperative body mass index (BMI was 48±7.0 kg/m2 (range 37.2–65.3. The mean postoperative BMI was 35 ± 5.9 kg/m2 (range 26.3–49. The mean percentage of excess weight loss (EWL was 63.1% (range 37.7–84.5, with a mean followup of 19.1 months (range 6–60. The mean levels of pre and post operative cholesterol were 194.4 ± 12.3 mg/dL (range 178–213 and 181 ± 16.3 mg/dL (range 158–200, respectively. Conclusion. Most patients with hyperlipidemia showed improvement or resolution of lipid profiles after LSG. Based on this systematic review, LSG has a significant effect on hyperlipidemia in the form of resolution or improvement in the majority of patients.

  19. Laparoscopic Sleeve Gastrectomy and Gastric Bypass for The Aging Population.

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    Yoon, James; Sherman, Jingjing; Argiroff, Alexandra; Chin, Edward; Herron, Daniel; Inabnet, William; Kini, Subhash; Nguyen, Scott

    2016-11-01

    Laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most common bariatric surgeries for treating morbid obesity. The purpose of this study is to determine differences in outcomes from RYGB or SG between patients ages ≥ 60 years and surgery performed, and their charts were reviewed up to 1 year post-operatively. Primary end points measured were mean length of stay, operative time, incidence of complications, and readmissions in the first post-operative year. A secondary end point measured was percent total weight loss (%TWL) and excess weight loss (%EWL). There were no significant differences between group < 60 and group ≥ 60 in operative time (210 vs. 229 min; p = 0.177), in-hospital post-operative complication rates (2.5 vs. 5 %; p = 1.0), long-term complication rates (2.5 vs. 10 %; p = 0.359), and 30-day readmission rates (2.5 vs. 12.5 %; p = 0.2). Patients in group < 60 had shorter lengths of stay (2.2 vs. 2.7 days; p = 0.031), but this difference is not clinically significant. Both groups achieved similar %TWL (21.4 vs. 20.5 %; p = 0.711) and %EWL (50.6 vs. 50.7 %; p = 0.986). Advanced age (≥60 years) is not a significant predictor of a worse outcome for SG and RYGB.

  20. Gastric Stenosis After Laparoscopic Sleeve Gastrectomy: Diagnosis and Management.

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    Rebibo, Lionel; Hakim, Sami; Dhahri, Abdennaceur; Yzet, Thierry; Delcenserie, Richard; Regimbeau, Jean-Marc

    2016-05-01

    The use of laparoscopic sleeve gastrectomy (LSG) is increasing worldwide. Although post-LSG gastric stenosis (GS) is less frequent, it has not been well defined and lacks standardized management procedures. The objective of the present study was to describe a series of patients with GS symptoms after LSG and to develop a standardized management procedure for this complication. We performed a retrospective analysis of a prospective database of patients presenting with GS after LSG procedures performed between January 2008 and March 2014. The primary efficacy criterion was the frequency of post-LSG GS. GS was classified as functional (i.e. a gastric twist) or organic. The secondary efficacy criteria included the time interval between LSG and diagnosis of GS, the type of stenosis, the type of management, and the follow-up data. During the study period, 1210 patients underwent primary or secondary LSG. Seventeen patients had post-operative symptoms of GS (1.4%); one patient had achalasia that had not been diagnosed preoperatively and thus was excluded from our analysis. The median time interval between LSG and diagnosis of GS was 47.2 days (1-114). Eleven patients had organic GS and six had functional GS. Seven patients required nutritional support. Endoscopic treatment was successful in 15 patients (88.2%) after balloon dilatation (n = 13) or insertion of a covered stent (n = 2). Two of the 15 patients required conversion to Roux-en-Y gastric bypass (11.8%). GS after LSG is a rare complication but requires standardized management. Most cases can be treated successfully with endoscopic balloon dilatation.

  1. Outcomes in Patients with Helicobacter pylori Undergoing Laparoscopic Sleeve Gastrectomy.

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    Brownlee, Andrew R; Bromberg, Erica; Roslin, Mitchell S

    2015-12-01

    In vertical sleeve gastrectomy (VSG), the majority of the stomach is resected and much of the tissue colonized with Helicobacter pylori and the bulk of acid producing cells are removed. In addition, the effect of H. pylori colonization of the stomach of patients undergoing stapling procedures is unclear. As a result, the need for detection and treatment of H. pylori in patients undergoing VSG is unknown. Four hundred and eighty patients undergoing VSG are the subject of this study. Three surgeons at a single institution performed the procedures. The remnant stomach was sent to pathology and tested for the presence of H. pylori using immunohistochemistry. All patients were discharged on proton pump inhibitors. Of the 480 patients who underwent VSG, 52 were found to be H. pylori positive based on pathology. There was no statistically significant difference in age (p = 0.77), sex (p = 0.48), or BMI (p = 0.39) between the groups. There were 17 readmissions post-op. Five of these were in the H. pylori positive cohort. Six of these complications were classified as severe (anastomotic leak, intra-abdominal collection, or abscess), with two in the H. pylori positive cohort (Table 1). There was no statistically significant difference in the severe complication rates between the two groups (p = 0.67). There were no readmissions for gastric or duodenal ulceration or perforation. Our data suggests that there is no increase in early complications in patients with H. pylori undergoing VSG. If these findings are confirmed in a long-term follow-up, it would mean that preoperative H. pylori screening in patients scheduled for VSG is not necessary.

  2. Preoperative Weight Loss and Operative Outcome After Laparoscopic Sleeve Gastrectomy.

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    Watanabe, Atsushi; Seki, Yosuke; Haruta, Hidenori; Kikkawa, Eri; Kasama, Kazunori

    2017-10-01

    Use of a preoperative diet before bariatric surgery to improve postoperative complications and weight loss has been reported. However, evidence supporting this diet for laparoscopic sleeve gastrectomy (LSG) is insufficient. We aimed to investigate postoperative outcomes influenced by preoperative diet before LSG. This study included 247 patients who underwent LSG after preoperative weight management. They were classified according to preoperative weight changes (group 1, weight gain; group 2, 0-3.0% total weight loss (TWL); group 3, 3.1-5.0% TWL; group 4, >5.1% TWL) and investigated for early postoperative complications and weight loss at 1 year. There were 37 patients in group 1, 79 in group 2, 64 in group 3, and 67 in group 4. There were no statistical differences in initial physical status among the 4 groups. The median BMI declined to 27.6 kg/m 2 in the entire group. Although the average %TWL during the combined preoperative and postoperative periods showed no statistical differences (P = 0.69), the average %TWL during the postoperative period decreased gradually as the extent of preoperative weight loss increased (P = 0.01). The early postoperative complication rate for the entire group was 6.9%; it tended to be lower as the extent of preoperative weight loss increased. However, a multiple logistic regression model demonstrated that the preoperative diet was not a statistical predictor of reduced early postoperative complications (P = 0.28). The extent of preoperative weight loss statistically affected postoperative weight loss. A preoperative diet might have minor advantages in reducing the risk of early postoperative complications.

  3. Role of serotonin hormone in weight regain after sleeve gastrectomy.

    Science.gov (United States)

    Demerdash, Hala M; Sabry, Ahmed A; Arida, Emad A

    Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as bariatric surgery, a small percentage of subjects regain weight after surgery. This study was designed to evaluate body weight changes over a period of two years after LSG and investigate the role of serotonin in regulating energy balance. This is a prospective cohort study. A total of 92 patients with morbid obesity (64 women and 28 men) underwent LSG. All the participants were subjected to physical examination and detailed medical history. Anthropometric measurements were accomplished pre-operative and post-operatively at a frequency of four times per year for two years follow-up. Laboratory investigations were performed pre-operatively, and one and two years post-operatively. Blood samples were collected in the fasting state; for glucose, lipid profile and hormonal assays. Hormones measured were plasma insulin, leptin, serotonin and ghrelin. Results revealed that 35.7% weight loss occurred after one year. However, there was variability in the individual weight loss curve during the period between the first and second post-operative years. Thus, patients were divided into two groups: group I included 78 patients (84%) who maintained the lost weight, and group II included 14 patients (16.0%) who regained weight within 24 months post-operatively. Correlation with BMI revealed positive correlation with leptin and serotonin, whilst negative correlation with ghrelin in group II patients. Mechanisms of weight loss after LSG are not only attributable to gastric restriction but also to the neurohormonal changes. In addition, serotonin may possibly contribute to the interplay of regulatory systems of energy homeostasis.

  4. Self-Regulation of Weight After Sleeve Gastrectomy.

    Science.gov (United States)

    Madeira, Teresa; do Carmo, Isabel; Bicha Castelo, Henrique; Santos, Osvaldo

    2018-03-01

    Bariatric surgery is recognized as the most effective method for achieving relevant weight loss in subjects with severe obesity. However, there is insufficient knowledge about weight self-regulation and quality of motivation in these patients. The main goal of this study was to characterize the association between the percentage of excess weight loss (%EWL) and the motivation to manage weight, at least 1 year after sleeve gastrectomy (SG). This is an observational longitudinal retrospective study. All patients corresponding to predefined inclusion criteria who underwent SG from January 2008 to July 2010 at a main general hospital were invited. A version of the Treatment Self-Regulation Questionnaire (TSRQ) was used to assess patients' quality of motivation: TSRQ concerning continuing the weight self-management program. Clinical data were collected from patients' records. Overall, 81 patients participated (16 men and 65 women, 25-64 years old). The average body mass index was significantly reduced from 45.3 ± 7.0 kg/m 2 preoperatively to 32.7 ± 6.9 kg/m 2 postoperatively. Autonomous self-regulation was higher than externally controlled self-regulation, regarding motives to keep managing weight after SG. Postoperatively, %EWL correlated negatively with external self-regulation. SG was found to be associated with the quality of motivation for losing weight. External motivations were associated with worse results. These findings support the importance of multiprofessional teams in the assessment and treatment of patients, aiming for the promotion of weight self-regulation after bariatric surgery.

  5. Predictors of weight loss 2 years after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Martin, David J; Lee, Crystal M Y; Rigas, Georgia; Tam, Charmaine S

    2015-08-01

    Despite the rapidly increasing popularity of laparoscopic sleeve gastrectomy (LSG), there is limited data examining weight loss more than 1 year after the procedure. There have also been few studies examining baseline predictors of weight loss after LSG. We aimed to examine the percentage of excess weight loss (%EWL) in patients 2 years after LSG and identify baseline predictors of %EWL. Electronic records from university hospitals were available for 292 patients who underwent LSG (205 women; mean age, 41.5 ± 11.1 years; mean weight, 126.5 ± 27.5 kg; mean BMI, 45.5 ± 7.5 kg/m(2) ). Variables assessed for predictive effect were baseline age, sex, BMI, presence of comorbidities (diabetes, hypertension, or obstructive sleep apnea), the amount of weight loss induced by a very low-calorie diet before surgery, and the number of clinic appointments attended over the 2 years. We performed linear regression and mixed model analyses between predictor variables and %EWL at 2 years. Adjusted %EWL was 31% at 2 weeks, 49% at 3 months, 64% at 6 months, 70% at 9 months, 76% at 12 months, 79% at 18 months, and 79% at 2 years. Multivariate analysis showed that lower baseline BMI, absence of hypertension, and greater clinic attendance predicted better %EWL (r(2)  = 0.11). Longer-term follow-up studies of weight loss post LSG are required to assist with patient care and management. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  6. Management of Distal Gastric Leak After Laparoscopic Sleeve Gastrectomy by Double Pigtail Catheter

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    Mani Habibi

    2016-07-01

    Full Text Available Gastric leakage postsurgery is the most feared complication of laparoscopic sleeve gastrectomy due to the difficulty of its management. While gastric leakagemanagement postsurgery is often performed using internal drainage catheters accompanied by self-expandable metal stents, endoscopic internal drainage by double pigtail catheter has recently become a recommended approach. Here we describe our treatment of a patient who experienced distal gastric leakage after undergoing laparoscopic sleeve gastrectomy using double pigtail catheter and our treatment recommendations based on the patient outcome.

  7. Laparoscopic gastric bypass vs sleeve gastrectomy in obese Korean patients.

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    Park, Ji Yeon; Kim, Yong Jin

    2015-11-28

    To compare the mid-term outcomes of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in obese Korean patients. All consecutive patients who underwent either LSG or LRYGB with primary to treat morbid obesity between January 2011 and December 2012 were retrospectively reviewed. Patients with a body mass index (BMI) ≥ 30 kg/m(2) with inadequately controlled obesity-related comorbidities (e.g., diabetes, obstructive sleep apnea, hypertension, or obesity-related arthropathy) or BMI ≥ 35 kg/m(2) were considered for bariatric surgery according to the International Federation for the Surgery of Obesity-Asia Pacific Chapter Consensus statements in 2011. The decision regarding the procedure type was made on an individual basis following extensive discussion with the patient about the specific risks associated with each procedure. All operative procedures were performed laparoscopically by a single surgeon experienced in upper gastrointestinal surgeries. Baseline demographics, perioperative surgical outcomes, and postoperative anthropometric data from a prospectively established database were thoroughly reviewed and compared between the two surgical approaches. One hundred four patients underwent LSG, and 236 underwent LRYGB. Preoperative BMI in the LSG group was significantly higher than that of the LRYGB group (38.6 kg/m(2) vs 37.2 kg/m(2), P = 0.024). Patients with diabetes were more prevalent in the LRYGB group (18.3% vs 35.6%, P = 0.001). Operating time and hospital stay were significantly shorter in the LSG group compared with the LRYGB group (100 min vs 130 min, P < 0.001; 1 d vs 2 d, P = 0.003), but the incidence of perioperative complications was similar between the groups (P = 0.351). The mean percentage of excess weight loss (%EWL) was 71.2% for LRYGB, while it was 63.5% for LSG, at mean follow-up periods of 18.0 and 21.0 mo, respectively (P = 0.073). The %EWL at 1, 3, 6, 12, 18, 24, and 36 mo was equivalent between the

  8. Clinical–radiologic evaluation of the complications of laparoscopic sleeve gastrectomy: Value of multidetector CT

    Directory of Open Access Journals (Sweden)

    Tamir A. Hassan

    2015-12-01

    Conclusions: As LSG is performed increasingly and frequently, it is essential for radiologists to recognize the normal postoperative anatomy and identify the complications of this procedure. CT is an important imaging tool to diagnose suspected complications of laparoscopic sleeve gastrectomy procedure to ensure accurate diagnosis.

  9. Does Preoperative Weight Change Predict Postoperative Weight Loss After Laparoscopic Sleeve Gastrectomy?

    OpenAIRE

    Sherman, William E.; Lane, Aaron E.; Mangieri, Christopher W.; Choi, Yong U.; Faler, Byron J.

    2015-01-01

    Background: Some institutions and insurance companies mandate a preoperative weight loss regimen prior to bariatric surgery. Previous studies suggest little to no correlation between preoperative and postoperative weight loss for laparoscopic Roux-en-Y gastric bypass (RNYGB). This study examined the impact of preoperative weight change for patients undergoing laparoscopic sleeve gastrectomy (LSG).

  10. Laparoscopic hand-assisted versus robotic-assisted laparoscopic sleeve gastrectomy: experience of 103 consecutive cases.

    Science.gov (United States)

    Kannan, Umashankkar; Ecker, Brett L; Choudhury, Rashikh; Dempsey, Daniel T; Williams, Noel N; Dumon, Kristoffel R

    2016-01-01

    Laparoscopic sleeve gastrectomy has become a stand-alone procedure in the treatment of morbid obesity. There are very few reports on the use of robotic approach in sleeve gastrectomy. The purpose of this retrospective study is to report our early experience of robotic-assisted laparoscopic sleeve gastrectomy (RALSG) using a proctored training model with comparison to an institutional cohort of patients who underwent laparoscopic hand-assisted sleeve gastrectomy (LASG). University hospital. The study included 108 patients who underwent sleeve gastrectomy either via the laparoscopic-assisted or robot-assisted approach during the study period. Of these 108 patients, 62 underwent LASG and 46 underwent RALSG. The console surgeon in the RALSG is a clinical year 4 (CY4) surgery resident. All CY4 surgery residents received targeted simulation training before their rotation. The console surgeon is proctored by the primary surgeon with assistance as needed by the second surgeon. The patients in the robotic and laparoscopic cohorts did not have a statistical difference in their demographic characteristics, preoperative co-morbidities, or complications. The mean operating time did not differ significantly between the 2 cohorts (121 min versus 110 min, P = .07). Patient follow-up in the LSG and RALSG were 91% and 90% at 3 months, 62% and 64% at 6 months, and 60% and 55% at 1 year, respectively. The mean percentage estimated weight loss (EWL%) at 3 months, 6 months, and 1 year was greater in the robotic group but not statistically significant (27 versus 22 at 3 mo [P = .05] and 39 versus 34 at 6 mo [P = .025], 57 versus 48 at 1 yr [P = .09]). There was no mortality in either group. Early results of our experience with RALSG indicate low perioperative complication rates and comparable weight loss with LASG. The concept of a stepwise education model needs further validation with larger studies. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc

  11. Metabolic effects of sleeve gastrectomy in female rat model of diet-induced obesity.

    Science.gov (United States)

    Brinckerhoff, Tatiana Z; Bondada, Sandhya; Lewis, Catherine E; French, Samuel W; DeUgarte, Daniel A

    2013-01-01

    Although women disproportionately undergo bariatric surgery, the rodent models investigating the mechanisms of bariatric surgery have been limited to males. Female rodent models can also potentially allow us to understand the effects of surgical intervention on future generations of offspring. Sleeve gastrectomy is an attractive weight loss procedure for reproductive-age female patients because it avoids the malabsorption associated with intestinal bypass. We sought to evaluate the effect of sleeve gastrectomy on young female rats with diet-induced obesity at the University of California, Los Angeles, David Geffen School of Medicine. Sprague-Dawley female rats were fed a 60% high-fat diet. At 12 weeks of age, the rats underwent either sleeve gastrectomy or sham surgery. The rats were killed 4 weeks after surgery. A chemistry panel was performed, and the serum adipokines and gut hormones were assayed. The homeostasis model assessment score was calculated. The liver histologic findings were graded for steatosis. The 2-sample t test was used to compare the results between the 2 groups. Sleeve gastrectomy was associated with significant weight loss (5% ± 6% versus -4% ± 6%; P resistance or steatohepatitis after 11 weeks of high-fat diet. Despite these limitations, additional gender-specific studies are warranted given that most bariatric surgeries are performed in women. Sleeve gastrectomy appears to result in weight loss and improvements in adiponectin and leptin by way of mechanisms independent of ghrelin levels in a female model of diet-induced obesity. Copyright © 2013 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  12. [Outcomes, controversies and gastric volume after laparoscopic sleeve gastrectomy in the treatment of obesity].

    Science.gov (United States)

    García-Díaz, Juan José; Ferrer-Márquez, Manuel; Moreno-Serrano, Almudena; Barreto-Rios, Rogelio; Alarcón-Rodríguez, Raquel; Ferrer-Ayza, Manuel

    2016-01-01

    Laparoscopic sleeve gastrectomy is a surgical procedure for the treatment of morbid obesity. However, there are still controversies regarding its efficiency in terms of weight reduction and incidence of complications. In this prospective study, the experience is presented of a referral centre for the treatment of morbid obesity with laparoscopic sleeve gastrectomy. A prospective study on 73 patients subjected to laparoscopic sleeve gastrectomy from February 2009 to September 2013. Patients were followed-up for a period of 12 months, evaluating the development of complications, reduction of gastric volume, and the weight loss associated with the surgery, as well as their impact on the improvement of comorbidities present at beginning of the study. There was a statistically a significantly reduction between the preoperative body mass index (BMI) and the BMI at 12 months after laparoscopic sleeve gastrectomy (p < 0.001), despite there being an increase in the gastric volume during follow-up, measured at one month and 12 months after surgery (p < 0.001). Five patients (6.85%) had complications, with none of them serious and with no deaths in the whole series. Laparoscopic sleeve gastrectomy is a safe and effective technique for the treatment of morbid obesity. Its use is associated with a significant reduction in the presence of comorbidities associated with obesity. Multicentre studies with a longer period of monitoring are required to confirm the efficacy and safety of this surgical technique. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  13. Laparoscopic Conversion of Gastric Bypass Complication to Sleeve Gastrectomy: Technique and Early Results.

    Science.gov (United States)

    Chen, Chung-Yen; Lee, Wei-Jei; Lee, Hui-Ming; Chen, Jung-Chien; Ser, Kong-Han; Lee, Yi-Chih; Chen, Shu-Chun

    2016-09-01

    Laparoscopic gastric bypass is a commonly performed bariatric surgery for the treatment of morbid obesity. Revision surgery for patients who have gastric bypass complications is a challenge for bariatric surgeon. Our aim is to present the early results of the conversions of gastric bypass complications to sleeve gastrectomies. From January 2001 to April 2015, 49 of 2382 gastric bypasses underwent revisional surgery to convert gastric bypasses to sleeve gastrectomies. The demographic data, surgical parameters, and outcomes were studied. The mean age of the study group was 35.0 years (range 20 to 55), and the average body mass index (BMI) prior to the reoperation was 25.3 kg/m(2). Seven patients had previous laparoscopic Roux-en-Y gastric bypasses (LRYGBs), and 42 had laparoscopic single anastomosis (mini-) gastric bypasses (LSAGBs). The main reasons for the revisions were malnutrition (58 %), weight regain (10 %), intolerance (18 %), and others (14 %). The revisional surgeries had longer operative times, greater blood loss, and longer flatus passage times than the primary gastric bypass surgeries. Four patients (8.1 %) developed major complications during revisional surgery, including three (6.1 %) cases of leakage and one (2.0 %) case of internal bleeding. No mortality was noted. After conversion to sleeve gastrectomy, the body weights of the patients remained stable, and all patients improved in terms of malnutrition, including anemia, hypoalbuminemia, and secondary hyperparathyroidism. Conversion to sleeve gastrectomy is an effective and safe option for patients with gastric bypass complications. The conversions to sleeve gastrectomy resulted in significant improvements in malnutrition and maintained weight loss at the early follow-ups.

  14. Prediction Model for Hemorrhagic Complications after Laparoscopic Sleeve Gastrectomy: Development of SLEEVE BLEED Calculator.

    Science.gov (United States)

    Janik, Michal R; Walędziak, Maciej; Brągoszewski, Jakub; Kwiatkowski, Andrzej; Paśnik, Krzysztof

    2017-04-01

    Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed bariatric procedures. Hemorrhagic complications (HC) after surgery are common and require surgical revision. Accurate estimation of the risk of postoperative HC can improve surgical decision-making process and minimize the risk of reoperation. The aim of the present study was to develop a predictive model for HC after LSG. The retrospective analysis of 522 patients after primary LSG was performed. Patients underwent surgery from January 2013 to February 2015. The primary outcome was defined as a surgical revision due to hemorrhagic complications. Multiple regression analysis was performed. The rate of hemorrhagic complications was 4 %. The mean age of patients was 41.0 (±11.6) years and mean BMI was 47.3 (±7.3) kg/m 2 . Of the 12 examined variables, four were associated with risk of HC. Protective factors for HC were no history of obstructive sleep apnea (odds ratio [OR] 0.22; 95 % CI 0.05-0.94) and no history of hypertension (OR 0.38; 95 % CI 0.14-1.05). The low level of expertise in bariatric surgery (OR 2.85; 95 % CI 1.08-7.53) and no staple line reinforcement (OR 3.34; 95 % CI 1.21-9.21) were associated with higher risk of HC. The result revealed the association between hemorrhagic complications and the following factors: obstructive sleep apnea, hypertension, level of expertise in bariatric surgery, and reinforcement of the staple line. The risk assessment model for hemorrhagic complications after LSG can contribute to surgical decision-making process.

  15. Sleeve gastrectomy effects on hunger, satiation, and gastrointestinal hormone and motility responses after a liquid meal test.

    Science.gov (United States)

    Mans, Esther; Serra-Prat, Mateu; Palomera, Elisabet; Suñol, Xavier; Clavé, Pere

    2015-09-01

    The relation between hunger, satiation, and integrated gastrointestinal motility and hormonal responses in morbidly obese patients after sleeve gastrectomy has not been determined. The objective was to assess the effects of sleeve gastrectomy on hunger, satiation, gastric and gallbladder motility, and gastrointestinal hormone response after a liquid meal test. Three groups were studied: morbidly obese patients (n = 16), morbidly obese patients who had had sleeve gastrectomy (n = 8), and nonobese patients (n = 16). The participants fasted for 10 h and then consumed a 200-mL liquid meal (400 kcal + 1.5 g paracetamol). Fasting and postprandial hunger, satiation, hormone concentrations, and gastric and gallbladder emptying were measured several times over 4 h. No differences were observed in hunger and satiation curves between morbidly obese and nonobese groups; however, sleeve gastrectomy patients were less hungry and more satiated than the other groups. Antrum area during fasting in morbidly obese patients was statistically significant larger than in the nonobese and sleeve gastrectomy groups. Gastric emptying was accelerated in the sleeve gastrectomy group compared with the other 2 groups (which had very similar results). Gallbladder emptying was similar in the 3 groups. Sleeve gastrectomy patients showed the lowest ghrelin concentrations and higher early postprandial cholecystokinin and glucagon-like peptide 1 peaks than did the other participants. This group also showed an improved insulin resistance pattern compared with morbidly obese patients. Sleeve gastrectomy seems to be associated with profound changes in gastrointestinal physiology that contribute to reducing hunger and increasing sensations of satiation. These changes include accelerated gastric emptying, enhanced postprandial cholecystokinin and glucagon-like peptide 1 concentrations, and reduced ghrelin release, which together may help patients lose weight and improve their glucose metabolism after

  16. Technical innovation: Intragastric Single Port Sleeve Gastrectomy (IGSG). A feasibility survival study on porcine model.

    Science.gov (United States)

    Estupinam, Oscar; Oliveira, André Lacerda de Abreu; Antunes, Fernanda; Galvão, Manoel; Phillips, Henrique; Scheffer, Jussara Peters; Rios, Marcelo; Zorron, Ricardo

    2018-01-01

    To perform technically the laparoscopic sleeve gastrectomy (LSG) using a unique Intragastric Single Port (IGSG) in animal swine model, evidencing an effective and safe procedure, optimizing the conventional technique. IGSG was performed in 4 minipigs, using a percutaneous intragastric single port located in the pre-pyloric region. The gastric stapling of the greater curvature started from the pre-pyloric region towards the angle of His by Endo GIA™ system and the specimen was removed through the single port. In the postoperative day 30, the animals were sacrificed and submitted to autopsy. All procedures were performed without conversion, and all survived 30 days. The mean operative time was 42 min. During the perioperative period no complications were observed during invagination and stapling. No postoperative complications occurred. Post-mortem examination showed no leaks or infectious complications. Intragastric Single Port is a feasible procedure that may be a suitable alternative technique of sleeve gastrectomy for the treatment of morbid obesity.

  17. Endoscopic treatment of the fistulas after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass

    Directory of Open Access Journals (Sweden)

    Luís Gustavo Santos Périssé

    Full Text Available OBJECTIVE: to evaluate the use of endoscopic self-expandable metallic prostheses in the treatment of fistulas from sleeve gastrectomy and Roux en y gastric bypass.METHODS: all patients were treated with fully coated auto-expandable metallic prostheses and were submitted to laparoscopic or CT-guided drainage, except for those with intracavitary drains. After 6-8 weeks the prosthesis was removed and if the fistula was still open a new prostheses were positioned and kept for the same period.RESULTS: the endoscopic treatment was successful in 25 (86.21% patients. The main complication was the migration of the prosthesis in seven patients. Other complications included prosthesis intolerance, gastrointestinal bleeding and adhesions. The treatment failed in four patients (13.7% one of which died (3.4%.CONCLUSION: endoscopic treatment with fully coated self-expandable prosthesis was effective in treating most patients with fistula after sleeve gastrectomy and roux en y gastric bypass.

  18. Simple, Safe, and Cost-Effective Technique for Resected Stomach Extraction in Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Derici, Serhan; Atila, Koray; Bora, Seymen; Yener, Serkan

    2016-01-01

    Background. Laparoscopic sleeve gastrectomy (LSG) has become a popular operation during the recent years. This procedure requires resection of 80-90% of the stomach. Extraction of gastric specimen is known to be a challenging and costly stage of the operation. In this paper, we report results of a simple and cost-effective specimen extraction technique which was applied to 137 consecutive LSG patients. Methods. Between October 2013 and October 2015, 137 laparoscopic sleeve gastrectomy surgeries were performed at Dokuz Eylul University General Surgery Department, Upper Gastrointestinal Surgery Unit. All specimens were extracted through a 15 mm trocar site without using any special device. Results. We noticed one superficial incisional surgical site infection and treated this patient with oral antibiotics. No cases of trocar site hernia were observed. Conclusion. Different techniques have been described for specimen extraction. This simple technique allows extraction of specimen safely in a short time and does not require any special device.

  19. Laparoscopic revisional surgery after Roux-en-Y gastric bypass and sleeve gastrectomy.

    Science.gov (United States)

    Morales, Mario P; Wheeler, Andrew A; Ramaswamy, Archana; Scott, J Stephen; de la Torre, Roger A

    2010-01-01

    Failure of primary bariatric surgery is frequently due to weight recidivism, intractable gastric reflux, gastrojejunal strictures, fistulas, and malnutrition. Of these patients, 10-60% will undergo reoperative bariatric surgery, depending on the primary procedure performed. Open reoperative approaches for revision to Roux-en-Y gastric bypass (RYGB) have traditionally been advocated secondary to the perceived difficulty and safety with laparoscopic techniques. Few studies have addressed revisions after RYGB. The aim of the present study was to provide our experience regarding the safety, efficacy, and weight loss results of laparoscopic revisional surgery after previous RYGB and sleeve gastrectomy procedures. A retrospective analysis of patients who underwent laparoscopic revisional bariatric surgery for complications after previous RYGB and sleeve gastrectomy from November 2005 to May 2007 was performed. Technical revisions included isolation and transection of gastrogastric fistulas with partial gastrectomy, sleeve gastrectomy conversion to RYGB, and revision of RYGB. The data collected included the pre- and postoperative body mass index, operative time, blood loss, length of hospital stay, and intraoperative and postoperative complications. A total of 26 patients underwent laparoscopic revisional surgery. The primary operations had consisted of RYGB and sleeve gastrectomy. The complications from primary operations included gastrogastric fistulas, refractory gastroesophageal reflux disease, weight recidivism, and gastric outlet obstruction. The mean prerevision body mass index was 42 ± 10 kg/m(2). The average follow-up was 240 days (range 11-476). The average body mass index during follow-up was 37 ± 8 kg/m(2). Laparoscopic revision was successful in all but 1 patient, who required conversion to laparotomy for staple line leak. The average operating room time and estimated blood loss was 131 ± 66 minutes and 70 mL, respectively. The average hospital stay was 6

  20. Stapling and Section of the Nasogastric Tube during Sleeve Gastrectomy: How to Prevent and Recover?

    OpenAIRE

    Péquignot, A.; Dhahria, A.; Mensah, E.; Verhaeghe, P.; Badaoui, R.; Sabbagh, C.; Regimbeau, J.-M.

    2011-01-01

    Bariatric surgery has become an integral part of morbid obesity treatment with well-defined indications. Some complications, specific or not, due to laparoscopic sleeve gastrectomy (LSG) procedure have recently been described. We report a rare complication unpublished to date: a nasogastric section during great gastric curve stapling. A 44-year-old woman suffered of severe obesity (BMI 36.6 kg/m2) with failure of medical treatments for years. According to already published technique, a LSG wa...

  1. Early Australian experience in robotic sleeve gastrectomy: a single site series.

    Science.gov (United States)

    Silverman, Candice D; Ghusn, Michael A

    2017-05-01

    The use of robotic platforms in bariatric surgery has recently gained relevance. With an increased use of this technology come concerns regarding learning curve effects during the initial implementation phase. The sleeve gastrectomy though may represent an ideal training procedure for introducing the robot into bariatric surgical practice. The present review of the first 10 consecutive robotic sleeve gastrectomy procedures performed in an Australian bariatric programme by a single surgeon describes the evolution of the technique, learning curve and initial patient outcomes. Between 2014 and 2015, robotic sleeve gastrectomies were performed as primary and revisional procedures by a consistent surgeon-assistant team. Technique evolution and theatre set-up were documented. Patient demographics, operative time (robot docking and total operation time), additional operative procedures performed, operative and post-operative complications at 1, 3 and 6 months post-procedure and weight loss achieved at 6 months were retrospectively reviewed from a prospectively maintained database. Ten robotic sleeve gastrectomies were performed without significant operative complications. One patient was treated as an outpatient with oral antibiotics for a superficial wound infection. The median total operative time was 123 min (interquartile range (IQR) 108.8-142.5), with a median incision to docking time of 19 min (IQR 15.0-31.8). Length of stay in hospital was 2-3 days. Median excess weight loss achieved at 6 months was 50% (IQR 33.9-66.5). This study describes a method of safely introducing the da Vinci robot into bariatric surgical practice. © 2016 Royal Australasian College of Surgeons.

  2. Laparoscopic Conversion of a Sleeve Gastrectomy to the Roux-en-Y Gastric Bypass.

    Science.gov (United States)

    Amor, Imed Ben; Debs, Tarek; Martini, Francesco; Elias, Bachir; Kassir, Radwan; Gugenheim, Jean

    2015-08-01

    After the failure of sleeve gastrectomy (SG), three options are available as a second intervention: the conversion into a biliopancreatic diversion with duodenal switch, the Roux-en-Y gastric bypass (RYGBP), and more recently, a re-SG consisting in the refashioning of a dilated gastric tube. We describe two different approaches for the conversion. The conversion to RYGBP remains a technically challenging operation but feasible and effective, and it should be reserved to specialized centers.

  3. The Effectiveness of Motivational Interviewing on Adherence to Treatment in Obese Patients Undergoing Sleeve Gastrectomy Surgery

    Directory of Open Access Journals (Sweden)

    2017-03-01

    Full Text Available Abstract Background & aim: Adherence is the degree of patient's success to do the health experts recommendations. The aim of present research was study the effects of motivational interviewing on adherence to in obese patients undergoing sleeve gastrectomy surgery. Methods: The design of present semi- experimental study was pre-test, post-test with control group. The statistical population included all obese patients (BMI≥35 that undergone laparoscopic sleeve gastrectomy surgery in Shiraz Ghadir Mother & Child Subspecialty Hospital, during the winter of 1394 and the spring of 1395. 30 of them were selected by using available sampling method and they randomly were asssigned to experimental (n=15 and control groups (n=15. The post bariatic surgery self-management behaviors questionnaire was used to collect data in two steps (pre-test and post-test. Motivational interviewing was implemented for the experimental group in four weeks (each week a 1/5 hour session. Data were analysed by using multivariate covariance analysis (MANCOVA. Results: MANCOVA results show that motivational interviewing led to a statistically significant difference between pre-test and post-test BSSQ total scores (P0/07. Conclusion: According to this study results, implementation of motivational interviewing is effective and appropriate in order to enhance adherence and self-management behaviors, achieve favorable weight loss & reduce postoperative complications, in obese patients undergoing sleeve gastrectomy surgery, but it appears that longer interventions are necessary to increase the rate of physical activity. Keywords: Motivational Interviewing, Adherence, Obese Patients, Sleeve Gastrectomy Surgery

  4. Endoscopic treatment of leaks after laparoscopic sleeve gastrectomy using MEGA esophageal covered stents.

    Science.gov (United States)

    Klimczak, Tomasz; Klimczak, Jerzy; Szewczyk, Tomasz; Janczak, Przemysław; Jurałowicz, Piotr

    2018-04-01

    Sleeve gastrectomy has become one of the main bariatric procedures over the last few years. This can be explained by the relative simplicity and high effectiveness of this method. Yet, it causes complications as any other method. Staple line leaks are the most frequent ones. According to different sources, this complication may occur with 0-7% frequency. Until 2013, surgery was the only effective treatment method for this complication. However, reoperations considerably increased treatment cost and patient morbidity. The aim of this study is to present the possibilities of endoscopic treatment of leaks after laparoscopic sleeve gastrectomy. From 2014 to 2016 14, cases of leaks following sleeve gastrectomy were diagnosed in our Department in Łódź. All of them were treated with MEGA stent in order to cover the leak site. Due to severe peritonitis, 3 patients had to undergo surgery prior to implantation of the prosthesis. Another patient underwent an unsuccessful attempt of leak closing via OTSC method prior to implantation of the prosthesis. Patients were nourished from the 3rd day after the surgery. On average, prostheses were removed on the 34th day after the implantation. The leak was fully sealed in 13 out of 14 cases. In 10 cases the leak was fully healed. There were 2 cases of patients' deaths: the result of a multi-organ failure in one case and early esophageal perforation in the other one. The overall success rate was 90.9%. Sealing leaks occurring after sleeve gastrectomy with MEGA stents represent an effective method and should become the technique of choice.

  5. Dry beriberi preceded Wernicke's encephalopathy: Thiamine deficiency after laparoscopic sleeve gastrectomy

    OpenAIRE

    Samanta, Debopam

    2015-01-01

    In recent times, pediatric obesity has become widely prevalent. If first-line treatment with lifestyle modification fails, bariatric surgery may be indicated for severely obese patients. Many patients now travel abroad to get these surgeries done. Some of these patients receive inadequate postoperative care. We described a morbidly obese 17-year-old girl who had a laparoscopic sleeve gastrectomy procedure for weight loss. Due to severe nausea, she stopped her multivitamin supplementation. Wit...

  6. Metabolic and histopathological effects of sleeve gastrectomy and gastric plication: an experimental rodent model

    OpenAIRE

    Gulcicek, Osman Bilgin; Ozdogan, Kamil; Solmaz, Ali; Yigitbas, Hakan; Alt?nay, Serdar; Gunes, Aysegul; Celik, Duygu Sultan; Yavuz, Erkan; Celik, Atilla; Celebi, Fatih

    2016-01-01

    Introduction: Obesity has recently become a major health problem, and researchers have been directed to work toward the development of surgical techniques, with new mediators playing an important role in nutrition. Gastric plication (GP) and sleeve gastrectomy (SG) have become popular recently. These are widely used techniques in bariatric surgery.Objectives: In this study, we aimed to compare the efficiency of SG and GP techniques on rats.Methods: Wistar-Hannover rats (n=18) were divided int...

  7. Portomesenteric Vein Thrombosis, Bowel Gangrene, and Bilateral Pulmonary Artery Embolism Two Weeks after Laparoscopic Sleeve Gastrectomy

    OpenAIRE

    Darcy, David G.; Charafeddine, Ali H.; Choi, Jenny; Camacho, Diego

    2015-01-01

    Sleeve gastrectomy and gastric bypass surgery are popular and effective options for weight loss surgery. Portomesenteric vein thrombosis (PMVT) is a documented but rare complication of bariatric surgery. Proper surgical technique, careful postoperative prophylaxis, and early mobilization are essential to prevent this event. The diagnosis of PMVT in the postoperative period requires a high index of suspicion and early directed intervention to prevent a possibly fatal outcome. We present a case...

  8. Laparoscopic sleeve gastrectomy without over-sewing of the staple line is effective and safe.

    Science.gov (United States)

    Kasalicky, Mojmir; Dolezel, Radek; Vernerova, Eva; Haluzik, Martin

    2014-03-01

    Laparoscopic sleeve gastrectomy (LSG) is a bariatric procedure with very good long-term weight-reducing and metabolic effects. Here we report 6 years' experience with LSG performed in morbidly obese patients by one surgical team focusing on the impact of the degree of sleeve restriction and safety of the procedure without over-sewing the staple line. From 2006 to 2012, 207 morbid obese patients with average age of 43.4 years and average body mass index 44.9 kg/m(2) underwent LSG without over-sewing the staple line. The complete 5- and 3-year follow-up is recorded in 59 and 117 patients with prospective data collection at 3, 6, 9, 12, 18, 24, 36, 42 and 60 months after LSG. Group 1 patients operated in 2006-2008 had smaller sleeve restriction. Group 2 patients operated in 2009-2012 had major sleeve restriction. All procedures were performed without over-sewing of the staple line. The average %EBMIL (excess body mass index loss) in group 1 patients with minor sleeve restriction reached 54.1% and average %EWL (excess weight loss) was 50.8% while in group 2 with major sleeve restriction the average %EBMIL reached 69.7% and average %EWL was 66.8%. Final weight reduction was significantly higher in group 2 patients compared to group 1 patients with smaller sleeve restriction. Out of 49 patients with preoperatively diagnosed T2DM (type 2 diabetes mellitus) was completely resolved in 70.8%. Pre-operatively diagnosed hypertension normalized in 64.2%, improved in 23.2%, and remained unchanged in 12.6% of patients. Carefully performed LSG without over-sewing the staple line is feasible and safe. A better weight-reducing effect was present in patients with major sleeve restriction.

  9. SLEEVE GASTRECTOMY IN PATIENTS WITH MORBID OBESITY AND HIV.

    Science.gov (United States)

    Pinto, José Máximo Costa; Lima, Marianna Gomes Cavalcanti Leite de; Almeida, Ana Luiza Melo Cavalcanti de; Sousa, Marcelo Gonçalves

    It is estimated that there are nearly 40 million people with the human immunodeficiency virus (HIV) worldwide. Due to the advent of antiretroviral drugs, it has been observed increasing in obesity and metabolic rates among patients undergoing treatment. Thus, numerous surgical therapies for weight loss are proposed for continuous improvement in health of patients with HIV, being the vertical gastrectomy an option for intact intestinal transit. To evaluate the applicability of the vertical gastrectomy in patients with morbid obesity and HIV. Was conducted a systematic review of the literature, in the electronic databases Scopus, Pubmed, Cinahl, Scielo, Cochrane and Lilacs, from 1998 to 2015. MeSH headings used in data collection were "Gastrectomy" and "Morbid obesity" being combined with the descriptor "HIV". Were found 2148 articles in Scopus, 1234 in PubMed and 784 in Cinahl. The articles were analyzed by the Jadad Quality Scale, being reduced to 40 articles, subsequently reassessed using an elaborated form by the Critical Appraisal Skills Programme (CASP), reaching 12 articles in the end. It was found that vertical gastrectomy constitutes a safe and effective method, with low mortality and low rate of postoperative complications, being recommended as surgical technique in patients with obesity, HIV and comorbidities. Estima-se que haja quase 40 milhões de pessoas com o vírus da imunodeficiência adquirida (HIV) no mundo. Com o advento dos antirretrovirais, observou-se aumento da obesidade e de taxas metabólicas nos pacientes em tratamento. Assim, inúmeras terapias cirúrgicas para a perda de peso estão sendo estudadas para a melhoria contínua da saúde dos pacientes com HIV, sendo a gastrectomia vertical uma opção de trânsito íntegro. Avaliar a aplicabilidade da gastrectomia vertical em pacientes com obesidade mórbida e HIV. Foi realizada revisão sistemática de literatura, de artigos publicados nas bases eletrônicas de dados Scopus, Pubmed, Cinahl

  10. Sleeve gastrectomy: have we finally found the holy grail of bariatric surgery? A review of the literature.

    Science.gov (United States)

    Kehagias, I; Zygomalas, A; Karavias, D; Karamanakos, S

    2016-12-01

    Laparoscopic sleeve gastrectomy has become one of the most commonly performed bariatric operations. It is essentially a restrictive bariatric operation; however, a series of hormonal changes occurring postoperatively contribute to decreased appetite and reduced food intake. This is a literature review of recent articles published on Pubmed, Medline and Google Scholar databases in English. Although, laparoscopic sleeve gastrectomy is commonly performed worldwide, there is still a lack of standardization regarding the surgical technique. Standardizing the surgical technique is essential in order to minimize postoperative complications and offer patients the best long-term weight loss. Laparoscopic sleeve gastrectomy appears to be an effective bariatric operation. It is relatively easy to perform, well tolerated by the patients and very effective regarding long-term excessive weight loss and resolution of the comorbidities, with minimum nutritional deficiencies.

  11. Postoperative effects of laparoscopic sleeve gastrectomy in morbid obese patients with type 2 diabetes.

    Science.gov (United States)

    Mihmanli, Mehmet; Isil, Riza Gurhan; Bozkurt, Emre; Demir, Uygar; Kaya, Cemal; Bostanci, Ozgur; Isil, Canan Tulay; Sayin, Pinar; Oba, Sibel; Ozturk, Feyza Yener; Altuntas, Yuksel

    2016-01-01

    Laparoscopic Sleeve Gastrectomy has become one of the most popular bariatric surgery types and helps treating not only obesity but also endocrinological diseases related to obesity. Therefore we aimed to evaluate the effects of laparoscopic sleeve gastrectomy on the treatment of type 2 diabetes. All patients, who underwent morbid obesity surgery during 2013-2014 and had a HbA1c >6 % were included in this prospective study. Demographical data, usage of oral antidiabetic drugs or insulin were recorded, and laboratory findings as HbA1c and fasting plasma glucose were evaluated preoperatively and postoperatively at the 6th and 12th months. Diabetes remission criteria were used to assess success of the surgical treatment. Totally 88 patients were included in this study. 55 patients were using oral antidiabetic drugs and 33 patients were using insulin. At the 6th month complete remission was observed in 80 (90.9 %), partial remission in 3 (3.4 %) and persistent diabetes in 5 (5.6 %) patients. At the 12th month complete remission was observed in 84 (95.4 %), partial remission in 1 (1.1 %) and persistent diabetes in 3 (3.4 %) patients. This study indicated that laparoscopic sleeve gastrectomy surgery achieved a complete remission of diabetes in 95.4 % patients having type 2 diabetes during a 1 year fallow up period. However, complete remission of type 2 diabetes has been reported as 80 % during long term fallow up in the literature. In our opinion this rate may change with longer follow up periods and studies involving more patients suffering type 2 diabetes.

  12. FXR is a molecular target for the effects of vertical sleeve gastrectomy

    DEFF Research Database (Denmark)

    Ryan, Karen K; Tremaroli, Valentina; Clemmensen, Christoffer

    2014-01-01

    Bariatric surgical procedures, such as vertical sleeve gastrectomy (VSG), are at present the most effective therapy for the treatment of obesity, and are associated with considerable improvements in co-morbidities, including type-2 diabetes mellitus. The underlying molecular mechanisms contributing......-X receptor, also known as NR1H4). We therefore examined the results of VSG surgery applied to mice with diet-induced obesity and targeted genetic disruption of FXR. Here we demonstrate that the therapeutic value of VSG does not result from mechanical restriction imposed by a smaller stomach. Rather, VSG...... molecular underpinning for the beneficial effects of this weight-loss surgery....

  13. The success of sleeve gastrectomy in the management of metabolic syndrome and obesity.

    Science.gov (United States)

    Shabbir, Asim; Dargan, Dallan

    2015-04-01

    The rapid reversal of diabetes, hypertension, hyperlipidaemia and obesity by surgical means has challenged accepted doctrines regarding the management of metabolic syndrome. Sleeve gastrectomy, which developed initially as a preparatory procedure for biliopancreatic diversion with duodenal switch, has seen an exponential rise in popularity as an effective lone laparoscopic bariatric procedure. Superior excess weight loss, a low complication rate, and excellent food tolerance, combined with a short hospital stay, have made this the procedure of choice for patients and surgeons across the globe. High volume centres nurture the ongoing development of experienced and specialized teams, pathways and regimens. Optimum surgical outcomes allow minimization of metabolic syndrome, reducing cardiovascular and cerebrovascular risk.

  14. Portomesenteric Vein Thrombosis, Bowel Gangrene, and Bilateral Pulmonary Artery Embolism Two Weeks after Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    David G. Darcy

    2015-01-01

    Full Text Available Sleeve gastrectomy and gastric bypass surgery are popular and effective options for weight loss surgery. Portomesenteric vein thrombosis (PMVT is a documented but rare complication of bariatric surgery. Proper surgical technique, careful postoperative prophylaxis, and early mobilization are essential to prevent this event. The diagnosis of PMVT in the postoperative period requires a high index of suspicion and early directed intervention to prevent a possibly fatal outcome. We present a case of PMVT complicated by small bowel ischemia resulting in gangrene that necessitated resection.

  15. Short-Term Pilot Study of the Effect of Sleeve Gastrectomy on Food Preference

    OpenAIRE

    Ammon, Brandon S.; Bellanger, Drake E.; Geiselman, Paula J.; Primeaux, Stefany D.; Yu, Ying; Greenway, Frank L.

    2015-01-01

    The effect of vertical sleeve gastrectomy (VSG) on food preference has not been examined in humans, but VSG decreases preference for fat and calorically dense foods in rodents. A validated Food Preference Questionnaire (FPQ) assessed food preference changes before and 6-weeks after VSG in humans. The FPQ was completed before and 43 ± 19 days (Mean ± SD) after VSG. Fifteen subjects (14 females) completed the study. Hedonic ratings decreased for foods high in fat and sugar (p = 0.002) and high ...

  16. A multicenter study of routine versus selective intraoperative leak testing for sleeve gastrectomy.

    Science.gov (United States)

    Bingham, Jason; Kaufman, Jedediah; Hata, Kai; Dickerson, James; Beekley, Alec; Wisbach, Gordon; Swann, Jacob; Ahnfeldt, Eric; Hawkins, Devon; Choi, Yong; Lim, Robert; Martin, Matthew

    2017-09-01

    Staple line leaks after sleeve gastrectomy are dreaded complications. Many surgeons routinely perform an intraoperative leak test (IOLT) despite little evidence to validate the reliability, clinical benefit, and safety of this procedure. To determine the efficacy of IOLT and if routine use has any benefit over selective use. Eight teaching hospitals, including private, university, and military facilities. A multicenter, retrospective analysis over a 5-year period. The efficacy of the IOLT for identifying unsuspected staple line defects and for predicting postoperative leaks was evaluated. An anonymous survey was also collected reflecting surgeons' practices and beliefs regarding IOLT. From January 2010 through December 2014, 4284 patients underwent sleeve gastrectomy. Of these, 37 patients (.9%) developed a postoperative leak, and 2376 patients (55%) received an IOLT. Only 2 patients (0.08%) had a positive finding. Subsequently, 21 patients with a negative IOLT developed a leak. IOLT demonstrated a sensitivity of only 8.7%. There was a nonsignificant trend toward increased leak rates when an IOLT was performed versus when IOLT was not performed. Leak rates were not statistically different between centers that routinely perform IOLT versus those that selectively perform IOLT. Routine IOLT had very poor sensitivity and was negative in 91% of patients who later developed postoperative leaks. The use of IOLT was not associated with a decrease in the incidence of postoperative leaks, and routine IOLT had no benefit over selective leak testing. IOLT should not be used as a quality indicator or "best practice" for bariatric surgery. Published by Elsevier Inc.

  17. De novo hiatal hernia of the gastric tube after sleeve gastrectomy.

    Science.gov (United States)

    Amor, Imed Ben; Debs, Tarek; Kassir, Radwan; Anty, Rodolphe; Amor, Virginie Ben; Gugenheim, Jean

    2015-01-01

    Sleeve gastrectomy (SG) is a frequently used surgical procedure for the treatment of morbid obesity. Several complications of SG have been described; however, de novo hiatal hernia of the gastric tube, as a complication of SG, has not been described in the literature. Here, we report a case of a hiatal hernia 2 years after SG. In the case reported here, the hiatal hernia was associated with weight regain. The mechanisms responsible for the herniation of the pouch are difficult to identify. Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass is an effective treatment for this complication. Its management is safe and effective. Obesity itself is an independent risk factor for hiatal hernia, found preoperatively in more than half of the morbidly obese patients. This predisposition is explained by higher intra-gastric pressure due to intra-abdominal or visceral fat, reduced inferior oesophageal sphincter pressure, and oesophageal motility problems. To our knowledge, this is the first described case of hiatal hernia of the gastric tube after SG. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  18. Improvement in severe pulmonary hypertension in obese patients after laparoscopic gastric bypass or sleeve gastrectomy.

    Science.gov (United States)

    Sheu, Eric G; Channick, Richard; Gee, Denise W

    2016-02-01

    Case reports have suggested that bariatric surgery improves pulmonary hypertension. We performed a retrospective, case-control study to evaluate the safety and efficacy of bariatric surgery in obese patients with severe pulmonary hypertension. Morbidly obese patients followed in a specialty pulmonary hypertension clinic who underwent laparoscopic gastric bypass or sleeve gastrectomy between 2008 and 2013 (n = 10) were compared to a BMI-matched cohort managed with maximal medical therapy (n = 10). Patients with advanced malignancy, prior heart/lung transplantation, and pulmonary hypertension from thromboembolism were excluded. Primary outcomes assessed were changes in use of pulmonary vasodilatory and diuretic medications, need for home oxygen therapy, and mean pulmonary arterial pressures. Secondary outcomes measured were excess body weight loss, perioperative mortality and morbidity, and hospital length of stay. More patients who underwent bariatric surgery experienced improvements in pulmonary arterial pressures (75 vs. 0%, p = 0.02), reduction in or discontinuation of pulmonary vasodilatory therapy (67 vs. 0%, p = 0.01), and decreased diuretic requirements (86 vs. 13%, p = 0.01) than the control cohort. Seventy-five percent of patients previously on home oxygen discontinued therapy after surgery, while oxygen requirements increased in 50% of the control cohort. Excess body weight loss was greater in the surgical group (EWL 68 vs. 19%, p Laparoscopic gastric bypass and sleeve gastrectomy in obese patients improves pulmonary hypertension in the short term.

  19. Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy: 3 Case Reports and a Literature Review

    Science.gov (United States)

    Muneer, Mohammed; Abdelrahman, Husham; El-Menyar, Ayman; Zarour, Ahmad; Awad, Ahmed; Dhaheri, Mahmood Al; Al-Thani, Hassan

    2016-01-01

    Case series Patient: Male, 27 • Female, 46 • Male, 46 Final Diagnosis: — Symptoms: Vague abdominal pain • severe nausea • vomiting • fever and diffuse abdominal tendernes Medication: — Clinical Procedure: — Specialty: — Objective: Rare co-existance of disease or pathology Background: Porto-mesenteric venous thrombosis (PMVT) is an infrequent but severe surgical complication developing in patients who underwent laparoscopic bariatric surgery (sleeve gastrectomy). Herein, we describe the clinical presentation, management, and outcome of 3 rare cases of PMVT after laparoscopic sleeve gastrectomy (LSG), successfully treated at our center. Case Report: All patients developed PMVT post-LSG and presented with diffused abdominal pain, nausea, and vomiting. Computed tomography (CT) of the abdomen confirmed the diagnosis of portal vein thrombosis. Two patients were treated conservatively with anticoagulation and thrombolytic therapy and the third patient required operative intervention with bowel resection. Conclusions: PMVT is a rare presentation after LSG, which requires early diagnosis and management. Conservative management through anticoagulants and thrombolytic therapy is quite effective and, if indicated, should always be considered as the primary treatment option. PMID:27068354

  20. Gastritis in patients undergoing sleeve gastrectomy: Prevalence, ethnic distribution, and impact on glycemic.

    Science.gov (United States)

    Rath-Wolfson, Lea; Varona, Roy; Bubis, Golan; Tatarov, Alexander; Koren, Rumelia; Ram, Edward

    2017-04-01

    Laparoscopic sleeve gastrectomy (LSG) is a therapeutic option in severely obese patients. The aim of this study was to evaluate the presence of Helicobacter pylori (HP) gastritis and non-Helicobacter gastritis in the gastrectomy specimens, and its association to other variables.One hundred six sleeve gastrectomy specimens were examined histopathologically for the presence of gastritis and its relation to other factors like ethnicity, glycemic control, and postoperative complications.Twelve patients had HP gastritis, 39 had non-HP gastritis, and 55 had normal mucosa. There was a statistical difference between the Arab and Jewish Israeli patients in our study. Twenty-eight of the Arab patients had HP gastritis and 48% had non-HP gastritis. In the Jewish population 6% had HP gastritis and 34% had non-HP gastritis. The preoperative glycemic control was worse in the gastritis group with a mean HbA1c of 8.344% while in the normal mucosa group the mean HbA1c was 6.55. After operation the glycemic control reverted to normal in most the diabetic patients. There were few postoperative complications however, they were not related to HP.There is a high incidence of gastritis in obese patients. The incidence of gastritis in the Arab population in our study was higher than that in the Jewish population. The glycemic control before surgery was worse in patients with gastritis than in the normal mucosa group. HP bares no risk for postoperative complications after LSG and does not affect weight loss. However a larger cohort of patients must be studied to arrive at conclusive results.

  1. Resident education in robotic-assisted vertical sleeve gastrectomy: outcomes and cost-analysis of 411 consecutive cases.

    Science.gov (United States)

    Ecker, Brett L; Maduka, Richard; Ramdon, Andre; Dempsey, Daniel T; Dumon, Kristoffel R; Williams, Noel N

    2016-02-01

    Robotic technology is increasingly prevalent in bariatric surgery, yet there are national deficiencies in exposure of surgical residents to robotic techniques. The purpose of this study is to accurately characterize the perioperative outcomes of a resident teaching model using the robotic-assisted sleeve gastrectomy. University Hospital. We identified 411 consecutive patients who underwent robotic sleeve gastrectomy at our institution from a prospectively maintained administrative database. Perioperative morbidity, operative time, and supply cost of the procedure were analyzed. Mean operative time was 96.4±24.9 minutes; mean robot usage time was 63.9 minutes (range 30.0-122.0 min). Ninety-day morbidities included reoperation (0.72%), major bleeding complications (0.48%), staple line leak (0.24%), stricture (0.97%), need for blood transfusion (3.86%), surgical site infection (1.69%), deep vein thrombosis (0.48%), and pulmonary embolism (0.48%). Mortality was nil. The resident cohort achieved operative time plateaus after five consecutive cases. Subset analysis for fiscal year 2014 demonstrated significantly increased supply cost for robotic sleeve gastrectomy compared with its laparoscopic equivalent. Robotic-assisted sleeve gastrectomy can be instituted as a model for resident robotic education with rates of morbidity and operative times equivalent to historical laparoscopic controls. The robot's enhanced ergonomics and its opportunity for resident education must be weighed against its increased supply cost. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  2. Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch

    NARCIS (Netherlands)

    Homan, J.; Betzel, B; Aarts, E.O.; Laarhoven, K.J. van; Janssen, I.M.C.; Berends, F.J.

    2015-01-01

    BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain and other complications are reported. Demand for secondary surgery is rising, partly for these reasons.

  3. Feasibility and early outcomes of laparoscopic plicated sleeve gastrectomy: a case-control study

    Directory of Open Access Journals (Sweden)

    Tomasz Rogula

    2016-01-01

    Full Text Available Introduction : Sleeve gastrectomy (SG continues to gain popularity as a viable weight loss procedure with well-documented outcomes and procedure-specific adverse effects. It has become increasingly indicated for the treatment of morbid obesity. Aim of the research : To compare a novel approach to SG, which aims to reduce SG-specific complications, to the standard SG procedure. Material and methods : Sixteen morbidly obese patients with a mean body mass index (BMI of 48.5 kg/m 2 ± SD who underwent the novel laparoscopic plicated sleeve gastrectomy (LPSG were retrospectively studied. The control group included 18 patients who underwent laparoscopic SG. Study and control groups were matched for BMI and gender. Study group patients underwent a partial SG with imbrication of the distal 2/3 of the staple line with 2 cm overlap and 3–4 cm of the pre-pyloric stomach. Control group SG patients had their staple line oversewn without plication. Outcomes at 3, 6 and 12 months were compared and analyzed. Results: There was no statistically significant difference in weight loss at 12 months between the LPSG and SG groups. Postoperative nausea was comparable between the two groups. No major complications were noted in either group. Conclusions: The LPSG is a modification of the standard SG which has comparable outcomes, safety and feasibility. It may lead to a decrease in unwanted complications such as sleeve stricture or obstruction. Further studies on long-term outcomes are needed to assess its value as a bariatric procedure.

  4. Endoscopic Treatment of Early Gastric Obstruction After Sleeve Gastrectomy: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Mariana Nuno Costa

    2016-01-01

    Full Text Available Morbid obesity is an epidemic and complex disease which imposes a multidisciplinary approach. Laparoscopic sleeve gastrectomy has become a frequent procedure given its efficacy and safety compared to other surgical options. However, it isn’t free from complications. Lax gastric fixation or incorrect positioning of the stomach during surgery can result in early gastric outlet obstruction caused by a volvulus-like mechanism by rotation of the stomach around its anatomic axes. This report refers to two cases of post sleeve gastric torsion resulting in persisting vomiting after initiating oral intake. The diagnosis was confirmed by upper gastrointestinal-contrast study and gastroscopy. In both cases, a fully covered self-expandable metallic stent was inserted which prompted the gastric lumen to become permeable resulting in symptomatic resolution. The stents were removed endoscopically after two and three months. Beyond more than three years of follow-up, the patients remain asymptomatic and no recurring “stenosis” was noticed. In these cases the use of fully covered self-expandable metallic stents demonstrated to be effective and safe in the treatment of post sleeve gastric torsion.

  5. Laparoscopic sleeve gastrectomy with loop bipartition: A novel metabolic operation in treating obese type II diabetes mellitus.

    Science.gov (United States)

    Mui, Wilfred Lik-Man; Lee, Danny Wai-Hung; Lam, Katherine Kar-Yee

    2014-01-01

    We report the first case of laparoscopic sleeve gastrectomy with loop bipartition (a modified form of Santoro's operation) in the treatment of type II diabetes mellitus associated with obesity. A 46-year-old gentleman (baseline BMI 32.9; BW 98.5kg) with 7-year history of type II diabetes mellitus (DM) underwent the procedure in Hong Kong. The control of DM was poor even with intensive medical therapy before the operation. Standard laparoscopic sleeve gastrectomy (SG) was performed and a loop gastroileostomy was fashioned at the antrum 250cm from the ilececal valve without division of the 1st part of duodenum after SG. The resultant gastric tube has two outlets, one to the first part of duodenum and the other to the ileum with preferential passage of food through the gastroileostomy as shown on subsequent contrast study. The patient's recovery was uneventful. The excess BMI loss was 97% with complete normalization of all metabolic parameters at 1-year follow-up. This new surgical procedure (sleeve gastrectomy with loop bipartition: SG+LB) was evolved and derived from the combined concepts of sleeve gastrectomy with transit bipartition (SG+TB), single anastomosis duodenal-ileostomy (SADI), mini-gastric bypass (MGB) and duodenal-jejunal bypass (DJB) with less nutritional and surgical complications. Sleeve gastrectomy with loop bipartition may be a very effective and simple operation to treat uncontrolled DM associated with obesity with a lot of apparent advantages over most current metabolic procedures available at the moment. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. Sleeve gastrectomy severe complications: is it always a reasonable surgical option?

    Science.gov (United States)

    Moszkowicz, David; Arienzo, Roberto; Khettab, Idir; Rahmi, Gabriel; Zinzindohoué, Franck; Berger, Anne; Chevallier, Jean-Marc

    2013-05-01

    Laparoscopic sleeve gastrectomy (LSG) is widely adopted but exposes serious complications. A retrospective database analysis was done to study LSG staple line complications in a tertiary referral university center with surgical ICU experienced in treatment of morbid obesity and complications. Twenty-two consecutive patients were referred between January 2004 and February 2012 with postoperative gastric leak or stenosis after LSG. Interventions consisted in the control of intra-abdominal and general sepsis; restoration of staple line continuity or revision of LSG; nutritional support; treatment of associated complications. Main outcome measures concerned success rates of therapeutic strategies, morbidity and mortality rates, LOS, and time to cure. Thirteen patients (59 %) were referred after failure of reoperation (seven fistula repairs were attempted). Three patients received emergency surgery in our center with transorificial intubation and jejunostomy formation. An endoscopic stent was tried in nine patients but failed in 84.6 % of cases within 20 days (1-161). Seven patients (32 %) necessitated total gastrectomy within 217 days (0-1,915 days) for conservative treatment failure. Procedures under general anesthesia were required in 41 % of cases, organ failure was found in 55 % of cases, and central venous device infection in 40 %. Mortality rate was 4.5 % (n = 1). Patients with unfavorable evolution of LSG complications (death or additional gastrectomy) had more previous bariatric procedure (82 % vs. 18 %, p = 0.003). Median time to cure was 310 days (9-546 days). LSG exposes severe complications occurring in patients with benign condition. Endoscopic stents entail high failure rate. Total gastrectomy is required in one third of the cases.

  7. Acute pancreatitis as an unusual early post-operative complication following laparoscopic sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Ankush Sarwal

    2018-01-01

    Full Text Available Laparoscopic sleeve gastrectomy (LSG at present one of the most commonly performed surgical treatments for morbid obesity worldwide. There are some complications regarding this procedure in the literature. This report presents a patient who developed acute pancreatitis immediate post-LSG. Patient was referred to our institute on 10th post-operative day with a complaint of fever, nausea, abdominal pain and leucocytosis. A diagnostic laparoscopy showed pancreatitis. Post-operatively, the patient was managed on treatment line of acute pancreatitis and recovered well. LSG is a common procedure in bariatric, and the most common complications are leakage and bleeding from the suture line. However, we encountered pancreatitis after LSG which is a rarely reported complication after LSG. We hypothesise that the development of acute pancreatitis in patients undergoing LSG is not well recognised and reported.

  8. Mechanistic comparison between gastric bypass vs. duodenal switch with sleeve gastrectomy in rat models.

    Directory of Open Access Journals (Sweden)

    Yosuke Kodama

    Full Text Available BACKGROUND: Both gastric bypass (GB and duodenal switch with sleeve gastrectomy (DS have been widely used as bariatric surgeries, and DS appears to be superior to GB. The aim of this study was to better understand the mechanisms leading to body weight loss by comparing these two procedures in experimental models of rats. METHODS: Animals were subjected to GB, DS or laparotomy (controls, and monitored by an open-circuit indirect calorimeter composed of comprehensive laboratory animal monitoring system and adiabatic bomb calorimeter. RESULTS: Body weight loss was greater after DS than GB. Food intake was reduced after DS but not GB. Energy expenditure was increased after either GB or DS. Fecal energy content was increased after DS but not GB. CONCLUSION: GB induced body weight loss by increasing energy expenditure, whereas DS induced greater body weight loss by reducing food intake, increasing energy expenditure and causing malabsorption in rat models.

  9. Portomesenteric venous thrombosis after laparoscopic sleeve gastrectomy: A case report and a call for prevention

    Directory of Open Access Journals (Sweden)

    Parveen Bhatia

    2015-01-01

    Full Text Available Postoperative portomesenteric venous thrombosis (PMVT is being increasingly reported after bariatric surgery. It is variable and often a nonspecific presentation along with its potential for life-threatening and life-altering outcomes makes it imperative that it is prevented, detected early and treated optimally. We report the case of a 50-year-old morbidly obese man undergoing a laparoscopic sleeve gastrectomy who developed symptomatic PMVT two weeks postsurgery, which was successfully treated by anticoagulant therapy. We provide postulates to the etiopathological mechanism for this thrombotic entity. The growing recognition that obesity and bariatric surgery create a procoagulant state regionally and systemically provides impetus for designing the ideal protocol for PMVT prophylaxis, which could be more common than currently believed. We support the early screening for PMVT in the postbariatric surgical patient with unexplainable or intractable abdominal symptoms. The role of routine surveillance and the ideal duration of post-PMVT anticoagulation is yet to be elucidated.

  10. Short-term pilot study of the effect of sleeve gastrectomy on food preference.

    Science.gov (United States)

    Ammon, Brandon S; Bellanger, Drake E; Geiselman, Paula J; Primeaux, Stefany D; Yu, Ying; Greenway, Frank L

    2015-06-01

    The effect of vertical sleeve gastrectomy (VSG) on food preference has not been examined in humans, but VSG decreases preference for fat and calorically dense foods in rodents. A validated Food Preference Questionnaire (FPQ) assessed food preference changes before and 6 weeks after VSG in humans. The FPQ was completed before and 43 ± 19 days (Mean ± SD) after VSG. Fifteen subjects (14 females) completed the study. Hedonic ratings decreased for foods high in fat and sugar (p = 0.002) and high in fat and complex carbohydrate (p = 0.007). Fat preference (p = 0.048) decreased, VSG reduced preference for calorically dense foods high in fat, sugar, and complex carbohydrate, and these changes may contribute to the weight loss with VSG.

  11. Technical Options for Malabsorption Issues After Single Anastomosis Duodenoileal Bypass with Sleeve Gastrectomy.

    Science.gov (United States)

    Vilallonga, Ramon; Balibrea, José Maria; Curell, Anna; Gonzalez, Oscar; Caubet, Enric; Ciudin, Andrea; Ortiz-Zúñiga, Angel Michael; Fort, José Manuel

    2017-12-01

    Laparoscopic single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) is a recently developed one- or two-stage operation based on biliopancreatic diversion that is used to treat morbid obesity. Some midterm outcomes suggest that malabsorption is a possible complication following the procedure. Therefore, conversion to a less malabsorptive procedure may be required. We aim to describe and analyze the outcomes after laparoscopic conversion of SADI-S to non-malabsorptive or less malabsorptive procedures. From January 2015 to April 2017, five patients underwent laparoscopic conversion to single anastomosis duodenojejunal bypass with sleeve gastrectomy (SADJ-S) (video) following SADI-S, and one female patient underwent laparoscopic conversion to gastric bypass (GBP) following SADI-S, after presenting with severe protein-calorie malnutrition, nutritional deficiencies, poor quality of life, or increased number of bowel movements. Mean preoperative BMI was 24.0 kg/m 2 (20.4-27.5 kg/m 2 ). Four patients underwent SADI-S to SADJ-S conversions and one underwent a SADI-S to Roux-en-Y duodenojejunal bypass. All cases were performed laparoscopically. No relevant postoperative complications or mortality was reported and the mean hospital stay was 4.6 days. Malabsorptive symptoms resolved in all patients. All patients experienced weight regain. Mean BMI increase was 7.1 kg/m 2 (5-10.8 kg/m 2 ). Outcomes of laparoscopic conversion to SADJ-S or GBP after SADI-S were acceptable, showing clinical improvement of malnutrition, nutritional deficiencies, and quality of life in all cases. Weight regain must be advised. These techniques appear feasible and free of severe long-term complications. Further investigation is warranted to understand the best common channel length for patients undergoing SADI-S.

  12. Emotional food cravings predicts poor short-term weight loss following laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Janse Van Vuuren, Michéle A; Strodl, Esben; White, Katherine M; Lockie, Philip D

    2018-02-24

    Laparoscopic sleeve gastrectomy (LSG) incidence has increased worldwide. However, a proportion of patients achieve inadequate weight loss and some experience weight regain. Little is known of the influence of eating beliefs and behaviours in response to cravings on early weight loss trajectory. This study aimed to identify the post-surgery eating cravings that predicted patients not achieving excess weight loss outcome (EWL) at 6-8 months post-LSG. A total of 106 (80.7% female) participants who underwent LSG from four sites completed the questionnaires at 4-6 weeks post-bariatric surgery and 6 months post-LSG. Achieving hunger, negative affect, emotions experienced before or during food cravings or eating, and guilty feelings). Participants lost an average 64% EWL (SD = 21% EWL) 6-8 months after LSG surgery. Results indicated the overall model was significant and, of the nine variables, the emotional food craving subscale (adjusted OR = 4.19, p = .018) predicted a failure to achieve EWL. Emotional food cravings experienced 4-6 weeks following LSG may predict poor weight loss outcomes at 6 months. Statement of contribution What is already known on this subject? The prevalence of obesity has reached epidemic proportions worldwide. Bariatric surgery is currently the most viable and cost-effective treatment for obesity and shows sustainability. Laparoscopic sleeve gastrectomy (LSG) is now the most common procedure. Not all patients achieve excess weight loss outcome (EWL) following LSG. What does this study add? Emotional food cravings contribute to weight loss outcomes at 6 months' post-LSG surgery. Emotional food cravings may be a maladaptive coping mechanism that represents important area for early psychological intervention. © 2018 The British Psychological Society.

  13. High preoperative depression, phobic anxiety, and binge eating scores and low medium-term weight loss in sleeve gastrectomy obese patients: a preliminary cohort study. : Psychiatric factors and weight loss in obesity surgery

    OpenAIRE

    Brunault, Paul; Jacobi, David; Miknius, Vaïda; Bourbao-Tournois, Céline; Huten, Noël; Gaillard, Philippe; Couet, Charles; Camus, Vincent; Ballon, Nicolas

    2012-01-01

    International audience; OBJECTIVE: Although depression, anxiety, and binge eating are prevalent in candidates for bariatric surgery, their impact on weight loss is unknown following sleeve gastrectomy. This study assesses the associations between weight loss and preoperative depression, anxiety, and binge eating scores in patients undergoing sleeve gastrectomy for morbid obesity. METHOD: This cohort study included 34 patients who underwent sleeve gastrectomy for morbid obesity between May 200...

  14. Band removal and conversion to sleeve or bypass: are they equally safe?

    Science.gov (United States)

    Fernando Santos, B; Wallaert, Jessica B; Trus, Thadeus L

    2014-11-01

    Patients who require laparoscopic adjustable gastric band (LAGB) removal are often converted to sleeve gastrectomy (SG) or roux-en-Y gastric bypass (RYGB). The relative safety of these salvage bariatric procedures is unclear. We hypothesized that LAGB removal with conversion to SG (BSG) or RYGB (BRYGB) would be associated with higher morbidity and mortality compared to primary SG or RYGB. National Surgical Quality Improvement Project data (2005-2011) were analyzed. Patients undergoing SG, RYGB, BRYGB, and BSG were identified. The incidence of major complications, as well as mortality was compared between groups. Multivariate analysis was performed to identify patient factors and operation types associated with major complications or mortality. Odds ratios (OR) were calculated with 95 % confidence intervals (CI) with p value BSG (n = 130) patients. All groups had similar mean age (45 ± 11-years old). Salvage patients were more commonly female (89 vs. 79 %) and with lower body-mass index than primary bariatric patients (BMI 42 ± 8 vs. 46 ± 8 kg/m2). Major complication rates were 5.23 % (RYGB), 4.65 % (BRYGB), 3.95 % (SG) and 6.92 % (BSG), with 30-day mortality of 0.16 % (RYGB), 0.20 % (BRYGB), 0.08 % (SG) and 0.77 % (BSG). Multivariate analysis showed that compared to SG, RYGB, and BSG were independent predictors of major complications. Multivariate analysis of mortality showed BSG was an independent predictor of mortality compared to SG (OR 8.02, 95 % CI 1.08-59.34, p = 0.04). Band removal with conversion to RYGB is not associated with higher morbidity or mortality compared to primary RYGB. However, band removal with conversion to sleeve gastrectomy appears to be independently associated with a higher rate of major complications and mortality, and thus may not be the salvage procedure of choice.

  15. Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass: a 36-case series.

    Science.gov (United States)

    El Lakis, Mustapha A; Pozzi, Agostino; Chamieh, Jad; Safadi, Bassem

    2017-03-01

    Portomesenteric vein thrombosis following laparoscopic bariatric surgical procedures is a serious and potentially lethal complication. It is quite rare, and its clinical presentation, management, and sequelae remain poorly understood. We searched PubMed, Medline, Google Scholar, Ovid, and Cochrane databases for articles reporting case series and systematic reviews in the English language on patients who underwent laparoscopic bariatric surgery and had a subsequent portal or mesenteric vein thrombosis. Articles discussing laparoscopic gastric banding were excluded. A total of 14 articles reporting on 36 cases were found. We analyzed the pooled data from these case reports and series with emphasis on number of reported patients, demographics, time of diagnosis, risk factors, symptoms, management, complications, and sequelae. Portomesenteric vein thrombosis is not uncommon following laparoscopic bariatric surgery and appears to occur more after laparoscopic sleeve gastrectomy. Bariatric surgeons should have a high index of suspicion for early detection and treatment of this potentially lethal complication. Obese patients at high risk for venous thrombosis should be screened for genetic predisposition for hypercoagulable state and should be considered for extended thromboprophylaxis postoperatively.

  16. Enabling recruitment success in bariatric surgical trials: pilot phase of the By-Band-Sleeve study.

    Science.gov (United States)

    Paramasivan, S; Rogers, C A; Welbourn, R; Byrne, J P; Salter, N; Mahon, D; Noble, H; Kelly, J; Mazza, G; Whybrow, P; Andrews, R C; Wilson, C; Blazeby, J M; Donovan, J L

    2017-11-01

    Randomized controlled trials (RCTs) involving surgical procedures are challenging for recruitment and infrequent in the specialty of bariatrics. The pilot phase of the By-Band-Sleeve study (gastric bypass versus gastric band versus sleeve gastrectomy) provided the opportunity for an investigation of recruitment using a qualitative research integrated in trials (QuinteT) recruitment intervention (QRI). The QRI investigated recruitment in two centers in the pilot phase comparing bypass and banding, through the analysis of 12 in-depth staff interviews, 84 audio recordings of patient consultations, 19 non-participant observations of consultations and patient screening data. QRI findings were developed into a plan of action and fed back to centers to improve information provision and recruitment organization. Recruitment proved to be extremely difficult with only two patients recruited during the first 2 months. The pivotal issue in Center A was that an effective and established clinical service could not easily adapt to the needs of the RCT. There was little scope to present RCT details or ensure efficient eligibility assessment, and recruiters struggled to convey equipoise. Following presentation of QRI findings, recruitment in Center A increased from 9% in the first 2 months (2/22) to 40% (26/65) in the 4 months thereafter. Center B, commencing recruitment 3 months after Center A, learnt from the emerging issues in Center A and set up a special clinic for trial recruitment. The trial successfully completed pilot recruitment and progressed to the main phase across 11 centers. The QRI identified key issues that enabled the integration of the trial into the clinical setting. This contributed to successful recruitment in the By-Band-Sleeve trial-currently the largest in bariatric practice-and offers opportunities to optimize recruitment in other trials in bariatrics.

  17. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial.

    OpenAIRE

    Peterli Ralph; Steinert Robert E; Woelnerhanssen Bettina; Peters Thomas; Christoffel-Courtin Caroline; Gass Markus; Kern Beatrice; von Fluee Markus; Beglinger Christoph

    2012-01-01

    Background The mechanisms of amelioration of glycemic control early after laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) are not fully understood. Methods In this prospective, randomized 1-year trial, outcomes of LRYGB and LSG patients were compared, focusing on possibly responsible mechanisms. Twelve patients were randomized to LRYGB and 11 to LSG. These non-diabetic patients were investigated before and 1 week, 3 months, and 12 months after surgery. A...

  18. CT-Guided Percutaneous Drainage of Infected Collections Due to Gastric Leak After Sleeve Gastrectomy for Morbid Obesity: Initial Experience

    International Nuclear Information System (INIS)

    Kelogrigoris, M.; Sotiropoulou, E.; Stathopoulos, K.; Georgiadou, V.; Philippousis, P.; Thanos, L.

    2011-01-01

    This study was designed to evaluate the efficacy and safety of computed tomography (CT)-guided drainage in treating infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity. From January 2007 to June 2009, 21 patients (9 men and 12 women; mean age, 39.2 (range, 26–52) years) with infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity underwent image-guided percutaneous drainage. All procedures were performed using CT guidance and 8- to 12-Fr pigtail drainage catheters. Immediate technical success was achieved in all 21 infected collections. In 18 of 21 collections, we obtained progressive shrinkage of the collection with consequent clinical success (success rate 86%). In three cases, the abdominal fluid collection was not resolved, and the patients were reoperated. Among the 18 patients who avoided surgery, 2 needed replacement of the catheter due to obstruction. No major complications occurred during the procedure. The results of our study support that CT-guided percutaneous drainage is an effective and safe method to treat infected abdominal fluid collections due to gastric leak in patients who had previously underwent laparoscopic sleeve gastrectomy for morbid obesity. It may be considered both as a preparatory step for surgery and a valuable alternative to open surgery. Failure of the procedure does not, however, preclude a subsequent surgical operation.

  19. Metabolic and histopathological effects of sleeve gastrectomy and gastric plication: an experimental rodent model

    Directory of Open Access Journals (Sweden)

    Osman Bilgin Gulcicek

    2016-04-01

    Full Text Available Introduction: Obesity has recently become a major health problem, and researchers have been directed to work toward the development of surgical techniques, with new mediators playing an important role in nutrition. Gastric plication (GP and sleeve gastrectomy (SG have become popular recently. These are widely used techniques in bariatric surgery. Objectives: In this study, we aimed to compare the efficiency of SG and GP techniques on rats. Methods: Wistar-Hannover rats (n=18 were divided into three equal groups, namely SG, GP, and control. Blood samples were taken before the operation and on the 30th day after the operation. The weights of all rats were recorded both on first day and the 30th day after the operation. Serum gastrin, ghrelin, and leptin levels were also measured on the same days. For histopathological examination, gastrectomy was performed after the animals were sacrificed. Results: Average weight loss was 10% for the SG group and 6.5% for the GP group. One month after the operations, the decrease in the ghrelin and leptin levels of GP and SG groups was significant compared with the levels of the control group. Gastrin levels of the SG group increased significantly compared with those of the control group. Histopathological examination revealed that there was significant decrease in the ghrelin and leptin levels of the GP and SG groups compared with those of the control group. Foveolar hyperplasia (FH, cystic glandular dilatation, and fibrosis were significantly higher in the GP and SG groups compared with the control group. Conclusion: Although GP is not as effective as SG in terms of weight loss, it provides the same effectiveness in decreasing ghrelin and leptin levels. Histopathological findings revealed that FH, fibrosis, and the cystic glandular dilatation development rates were similar.

  20. Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative study.

    Science.gov (United States)

    Alqahtani, Aayed; Alamri, Hussam; Elahmedi, Mohamed; Mohammed, Rafiuddin

    2012-11-01

    Laparoscopic sleeve gastrectomy (LSG) is a recent bariatric procedure that has gained widespread popularity in morbidly obese adults. However, pediatric bariatric surgery is controversial, and the type(s) of bariatric surgery that are suitable for children and adolescents is under debate. No studies exit that compare LSG outcomes in adult and pediatric patients. We reviewed our experience to assess the safety, efficacy, and complications of LSG in adult and pediatric morbidly obese patients. A retrospective review of all patients who underwent LSG by a single surgeon between March 2008 and February 2011 was performed. The 222 patients included 108 pediatric patients aged 21 years or younger and 114 adult patients older than 21 years. Baseline, operative, perioperative, and available follow-up data were abstracted. Pediatric patients had a mean age of 13.9 ± 4.3 years and a mean baseline body mass index (BMI) of 49.6 kg/m(2), whereas adults had a mean age of 32.2 ± 9.4 years and a mean baseline BMI of 48.3 kg/m(2). Our pediatric group achieved a mean percent of excess weight loss (%EWL) of 32.4, 52.1, 65.8, and 64.9 % at 3, 6, 12, and 24 months postoperative, respectively, compared with a mean %EWL of 30.9, 55.2, 68.5, and 69.7 %, respectively, in our adult group (p > 0.05). During the 24-month follow-up period, pediatric patients attended 71.7 % of follow-up visits, whereas adults attended 61.2 % of follow-up visits (p = 0.01). Postoperative complications occurred in six (5.6 %) and eight (7 %) pediatric and adult patients, respectively. Laparoscopic sleeve gastrectomy in the pediatric age group is of similar safety and effectiveness compared with adults. Pediatric patients had fewer major complications and were more compliant with follow-up than adults. Nevertheless, long-term results are required to further clarify the safety and effectiveness of LSG in pediatric patients.

  1. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial.

    Science.gov (United States)

    Peterli, Ralph; Wölnerhanssen, Bettina Karin; Peters, Thomas; Vetter, Diana; Kröll, Dino; Borbély, Yves; Schultes, Bernd; Beglinger, Christoph; Drewe, Jürgen; Schiesser, Marc; Nett, Philipp; Bueter, Marco

    2018-01-16

    Sleeve gastrectomy is increasingly used in the treatment of morbid obesity, but its long-term outcome vs the standard Roux-en-Y gastric bypass procedure is unknown. To determine whether there are differences between sleeve gastrectomy and Roux-en-Y gastric bypass in terms of weight loss, changes in comorbidities, increase in quality of life, and adverse events. The Swiss Multicenter Bypass or Sleeve Study (SM-BOSS), a 2-group randomized trial, was conducted from January 2007 until November 2011 (last follow-up in March 2017). Of 3971 morbidly obese patients evaluated for bariatric surgery at 4 Swiss bariatric centers, 217 patients were enrolled and randomly assigned to sleeve gastrectomy or Roux-en-Y gastric bypass with a 5-year follow-up period. Patients were randomly assigned to undergo laparoscopic sleeve gastrectomy (n = 107) or laparoscopic Roux-en-Y gastric bypass (n = 110). The primary end point was weight loss, expressed as percentage excess body mass index (BMI) loss. Exploratory end points were changes in comorbidities and adverse events. Among the 217 patients (mean age, 45.5 years; 72% women; mean BMI, 43.9) 205 (94.5%) completed the trial. Excess BMI loss was not significantly different at 5 years: for sleeve gastrectomy, 61.1%, vs Roux-en-Y gastric bypass, 68.3% (absolute difference, -7.18%; 95% CI, -14.30% to -0.06%; P = .22 after adjustment for multiple comparisons). Gastric reflux remission was observed more frequently after Roux-en-Y gastric bypass (60.4%) than after sleeve gastrectomy (25.0%). Gastric reflux worsened (more symptoms or increase in therapy) more often after sleeve gastrectomy (31.8%) than after Roux-en-Y gastric bypass (6.3%). The number of patients with reoperations or interventions was 16/101 (15.8%) after sleeve gastrectomy and 23/104 (22.1%) after Roux-en-Y gastric bypass. Among patients with morbid obesity, there was no significant difference in excess BMI loss between laparoscopic sleeve gastrectomy and laparoscopic Roux

  2. Effects of sleeve gastrectomy in neonatally streptozotocin-induced diabetic rats.

    Directory of Open Access Journals (Sweden)

    Yan Wang

    Full Text Available BACKGROUND: Sleeve gastrectomy (SG has emerged recently as a stand-alone bariatric procedure to treat morbid obesity and enhance glucose homeostasis. The aim of the study was to evaluate its effects in neonatally streptozotocin (STZ-induced diabetic rats (n-STZ diabetic rats. METHODOLOGY AND PRINCIPAL FINDINGS: To induce diabetes, STZ (90 mg/kg was administered intraperitoneally to 2-day-old male pups. When 12 weeks old, diabetic rats were randomized into sleeve operation group (SLG, n = 6 and sham operation group (SOG, n = 6. Body weights were monitored weekly, and daily consumption of water and food were followed for eight consecutive weeks postoperatively. Serum glucose levels were measured periodically at the 4th and 8th week after surgery. Insulin, ghrelin, glucose-dependent insulinotropic polypeptide (GIP and Glucagon-like peptide-1 (GLP-1 levels were assayed at the end of the study. Our data showed that SLG rats exhibited significantly lower body weight gain in addition to reduced food and water intakes postoperatively compared to their sham-operation counterparts. However, resolution of diabetes was not observed in our study. Correspondingly, there were no significant differences between SOG rats and SLG rats in glucose metabolism-associated hormones, including insulin, GIP and GLP-1. In contrast, ghrelin level significantly decreased (P<0.01 in SLG group (58.01 ± 3.75 pg/ml after SG surgery compared to SOG group (76.36 ± 3.51 pg/ml. CONCLUSIONS: These observations strongly suggest that SG is effective in controlling body weight. However, SG did not achieve resolution or improvement of diabetes in n-STZ diabetic rats.

  3. Laparoscopic sleeve gastrectomy with endoscopic versus bougie calibration: results of a prospective study.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Sola-Vera, Javier; Miranda, Elena; Muñoz, José Luis; Perez-Rabasco, Estefania; Arroyo, Antonio; Calpena, Rafael

    2014-10-01

    The use of the endoscope for the calibration of the gastric sleeve, instead of the standard use of the bougie, is a safe procedure and gives the surgeon a higher sense of security. The aim of this study was to evaluate the effect of the use of endoscopic guidance on postoperative complications and mid-term results of the bariatric procedure. A prospective, nonrandomized study was performed at the General University Hospital of Elche (Alicante, Spain) between 2010 and 2013. The patients were divided into the bougie calibration group and the endoscopic calibration group. The decision of which method to use depended on the availability of an endoscopist at the time of the surgery. Fifty patients were included in the study, 44 females (88%) and 6 males (12%), with a mean age of 43.3 years and a preoperative mean body mass index of 50.6 kg/m(2). In the endoscopic calibration group, a bleeding point in the staple line was detected and sclerosed with adrenaline in 1 patient. In the bougie calibration group there were no cases of postoperative digestive bleeding. The intraoperative tightness check with blue dye and air insufflation through an orogastric tube in the bougie calibration group was negative in all the patients. In the endoscopic calibration group the check with blue dye was also negative in all cases, but the second test with air detected the exit of air bubbles in 1 case. There were no significant differences in the operation time between groups. A significant reduction in the major complications rate was observed in the endoscopic calibration group (odds ratio=0.9; P=.034). Endoscopic calibration is associated with lower postoperative complications after laparoscopic sleeve gastrectomy.

  4. Laparoscopic sleeve gastrectomy: review of 500 cases in single surgeon Australian practice.

    Science.gov (United States)

    Gibson, Simon C; Le Page, Philip A; Taylor, Craig J

    2015-09-01

    Reported results and techniques of laparoscopic sleeve gastrectomy (LSG) are variable. Our objective was to assess results of weight loss, complications and reflux in a large consecutive series of LSG, describing technical detail which contributed to outcomes. Retrospective review of prospectively collected data of 500 consecutive patients undergoing LSG. Patient demographics, weight loss, complications and functional outcomes were analysed and operative technique described. Five hundred patients underwent LSG over 3 years (37 revisional). Mean (range) preoperative body mass index was 45 kg/m(2) (35-76 kg/m(2) ). Mean follow-up and length of hospital stay were 14 months (1-34) and 3.8 days (3-12), respectively. All-cause 30-day readmission rate 1.2%. Mean excess weight loss (interquartile range, available patient data) was 43% (22-65%, 423 patients), 58% (45-70%, 352 patients), 76% (52-84%, 258 patients), 71% (51-87%, 102 patients) and 73% (55-86%, 13 patients) at 3, 6, 12, 24, 36 months, respectively. There was no mortality. Intraoperative complications occurred in two (0.4%) - splenic bleeding; bougie related oesophageal injury. Early surgical complications in four (1.2%) patients (one staple line leak and three post-operative bleeds). Other early complications occurred in three (0.6%) patients (one pseudomembranous colitis; one central line sepsis; one portal venous thrombosis) and late in four (0.8%) patients (three port-site incisional hernias; mid-sleeve stricture requiring endoscopic dilatation). Gastro-oesophageal reflux symptoms decreased from 45 to 6%. With attention to detail, LSG can lead to good excess weight loss with minimal complications. Tenants to success include repair of hiatal laxity, generous width at angula incisura and complete resection of posterior fundus. © 2013 Royal Australasian College of Surgeons.

  5. Rodent vertical sleeve gastrectomy alters maternal immune health and fetoplacental development.

    Science.gov (United States)

    Spann, Redin A; Lawson, William J; Bidwell, Gene L; Zamarripa, C Austin; Maranon, Rodrigo O; Bandyopadhyay, Sibali; Taylor, Erin R; Reckelhoff, Jane F; Garrett, Michael R; Grayson, Bernadette E

    2018-01-31

    Bariatric surgery is increasingly employed to improve fertility and reduce obesity-related co-morbidities in obese women. Surgical weight loss not only improves the chance of conception but reduces the risk of pregnancy complications including pre-eclampsia, gestational diabetes, and macrosomia. However, bariatric procedures increase the incidence of intrauterine growth restriction (IUGR), fetal demise, thromboembolism, and other gestational disorders. Using our rodent model of vertical sleeve gastrectomy (VSG), we tested the hypothesis that VSG in diet-induced, obese dams would cause immune and placental structural abnormalities that may be responsible for fetal demise during pregnancy. VSG dams studied on gestational day (G) 19 had reduced circulating T-cell (CD3 + and CD8 + ) populations compared with lean or obese controls. Further, local interleukin (IL) 1β and IL 1 receptor antagonist ( il1rn ) cmRNA were increased in placenta of VSG dams. Placental barrier function was also affected, with increased transplacental permeability to small molecules, increased matrix metalloproteinase 9 expression, and increased apoptosis in VSG. Furthermore, we identified increased placental mTOR signaling that may contribute to preserving the body weight of the fetuses during gestation. These changes occurred in the absence of a macronutrient deficit or gestational hypertension in the VSG dams. In summary, previous VSG in dams may contribute to fetal demise by affecting maternal immune system activity and compromise placental integrity. © 2018 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society.

  6. Stapling and Section of the Nasogastric Tube during Sleeve Gastrectomy: How to Prevent and Recover

    Directory of Open Access Journals (Sweden)

    A. Péquignot

    2011-07-01

    Full Text Available Bariatric surgery has become an integral part of morbid obesity treatment with well-defined indications. Some complications, specific or not, due to laparoscopic sleeve gastrectomy (LSG procedure have recently been described. We report a rare complication unpublished to date: a nasogastric section during great gastric curve stapling. A 44-year-old woman suffered of severe obesity (BMI 36.6 kg/m2 with failure of medical treatments for years. According to already published technique, a LSG was performed. Six hours postoperatively, a nurse removed the nasogastric tube according to the local protocol and the nasogastric tube was abnormally short, with staples at its extremity. Surgery was performed with peroperative endoscopy. In conclusion, this is the first publication of a nasogastric section during LSG. Therefore we report this case and propose a solution to prevent its occurrence. To avoid this kind of accident, we now systematically insert the nasogastric tube by mouth through a Guedel cannula. Then, to insert the calibrating bougie, we entirely withdraw the nasogastric tube.

  7. Vertical sleeve gastrectomy improves indices of metabolic disease in rodent model of surgical menopause

    Science.gov (United States)

    Lawson, William J.; Shirey, Kristin; Spann, Redin A.; Zamarripa, C. Austin; Hosler, Jonathan P.; Grayson, Bernadette E.

    2016-01-01

    Objective Though females are the most common recipients of weight loss surgeries for the amelioration of the comorbidities of obesity, few studies have addressed the efficacy of these procedures with specific attention to reproductive stage. Here we ask in a rodent model of vertical sleeve gastrectomy (VSG) whether improvements to metabolic health are realized in females having received surgical menopause. Specifically we were interested in knowing whether rats made menopausal through surgical means would exhibit persistent hepatic steatosis as reported in previously pregnant, freely-cycling female VSG rats or if it is resolved as reported in male VSG rats. Methods All the rats first received ovariectomy (OVX) and then were placed on high fat diet (HFD) prior to either sham or VSG surgery (N = 12, 9) and then were monitored for resolution of obesity-related comorbidities. Results VSG was sufficient to reduce weight and adiposity in OVX females in comparison to Obese rats (P change in insulin sensitivity. Both circulating (P < 0.01) and hepatic triglyceride (P < 0.01) levels were also reduced after VSG. Liver integrity was improved in OVX-VSG in comparison to OVX-Obese as reflected by reduced aspartate aminotransferase (AST) levels (P < 0.05). The ability of mitochondria to generate ATP was maintained and an increase in complex IV may decrease the production of mitochondrial ROS. Conclusions Taken together, VSG in ovariectomized animals experience many positive benefits including the resolution of hepatic steatosis that persists in reproductively-intact female rats after VSG. PMID:27801704

  8. Stapling and Section of the Nasogastric Tube during Sleeve Gastrectomy: How to Prevent and Recover?

    Science.gov (United States)

    Péquignot, A; Dhahria, A; Mensah, E; Verhaeghe, P; Badaoui, R; Sabbagh, C; Regimbeau, J-M

    2011-01-01

    Bariatric surgery has become an integral part of morbid obesity treatment with well-defined indications. Some complications, specific or not, due to laparoscopic sleeve gastrectomy (LSG) procedure have recently been described. We report a rare complication unpublished to date: a nasogastric section during great gastric curve stapling. A 44-year-old woman suffered of severe obesity (BMI 36.6 kg/m2) with failure of medical treatments for years. According to already published technique, a LSG was performed. Six hours postoperatively, a nurse removed the nasogastric tube according to the local protocol and the nasogastric tube was abnormally short, with staples at its extremity. Surgery was performed with peroperative endoscopy. In conclusion, this is the first publication of a nasogastric section during LSG. Therefore we report this case and propose a solution to prevent its occurrence. To avoid this kind of accident, we now systematically insert the nasogastric tube by mouth through a Guedel cannula. Then, to insert the calibrating bougie, we entirely withdraw the nasogastric tube.

  9. Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Alter the Gut-Brain Communication

    Directory of Open Access Journals (Sweden)

    L. A. Ballsmider

    2015-01-01

    Full Text Available This study investigated the anatomical integrity of vagal innervation of the gastrointestinal tract following vertical sleeve gastrectomy (VSG and Roux-en-Y gastric bypass (RYGB operations. The retrograde tracer fast blue (FB was injected into the stomach to label vagal neurons originating from nodose ganglion (NG and dorsal motor nucleus of the vagus (DMV. Microglia activation was determined by quantifying changes in the fluorescent staining of hindbrain sections against an ionizing calcium adapter binding molecule 1 (Iba1. Reorganization of vagal afferents in the hindbrain was studied by fluorescent staining against isolectin 4 (IB4. The density of Iba1- and IB4-immunoreactivity was analyzed using Nikon Elements software. There was no difference in the number of FB-labeled neurons located in NG and DMV between VSG and VSG-sham rats. RYGB, but not RYGB-sham rats, showed a dramatic reduction in number of FB-labeled neurons located in the NG and DMV. VSG increased, while the RYGB operation decreased, the density of vagal afferents in the nucleus tractus solitarius (NTS. The RYGB operation, but not the VSG procedure, significantly activated microglia in the NTS and DMV. Results of this study show that the RYGB, but not the VSG procedure, triggers microglia activation in vagal structures and remodels gut-brain communication.

  10. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques.

    Science.gov (United States)

    Dapri, Giovanni; Cadière, Guy Bernard; Himpens, Jacques

    2010-04-01

    Gastric leak and hemorrhage are the most important challenges after laparoscopic sleeve gastrectomy (LSG). In order to reduce these complications, the staple line can be reinforced by absorbable sutures or by the use of glycolide trimethylene carbonate copolymer onto the linear stapler (Gore Seamguard; W.L. Gore & Associates, Inc, Flagstaff, AZ). To our knowledge, there are no randomized studies showing the utility of staple line reinforcement during LSG. The purpose of this study was to randomly compare three techniques in LSG: no staple line reinforcement (group 1), buttressing of the staple line with Gore Seamguard (group 2), and staple line suturing (group 3). Between January 2008 and February 2009, 75 patients were prospectively and randomly enrolled in the three different techniques of handling the staple line during LSG. The patient groups were similar (NS). Mean operative time to perform the stomach sectioning was 15.9 +/- 5.9 min (group 1), 20.8 +/- 8.1 min (group 2), and 30.8 +/- 10.1 min (group 3) (p Gore Seamguard statistically reduces blood loss during stomach sectioning as well as overall blood loss. No staple line reinforcement statistically decreases the time to perform stomach sectioning and the total operative time. No significant difference is evidenced in terms of postoperative leak between the three techniques of LSG.

  11. Integrated Approaches for the Management of Staple Line Leaks following Sleeve Gastrectomy

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    Mauro Montuori

    2017-01-01

    Full Text Available Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years’ experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%. All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6–34 days, SD ± 11.85. We recorded one death (16.67% due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26–83 days; SD ± 25.44. Conclusion. Choosing the proper treatment depends on clinical stability and on the presence or not of collected abscess. Our treatment protocol showed being associated with low complication rate and minor discomfort to the patients, reducing the need for more invasive procedures.

  12. Dry beriberi preceded Wernicke's encephalopathy: Thiamine deficiency after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Samanta, Debopam

    2015-01-01

    In recent times, pediatric obesity has become widely prevalent. If first-line treatment with lifestyle modification fails, bariatric surgery may be indicated for severely obese patients. Many patients now travel abroad to get these surgeries done. Some of these patients receive inadequate postoperative care. We described a morbidly obese 17-year-old girl who had a laparoscopic sleeve gastrectomy procedure for weight loss. Due to severe nausea, she stopped her multivitamin supplementation. Within a few weeks, she developed symptoms of dry beriberi was soon followed by classic symptoms of Wernicke's encephalopathy. The prompt diagnosis was made with confirmation from serum thiamine level and brain magnetic resonance imaging. Thiamine supplementation reversed ophthalmological symptoms promptly. However, the patient needed inpatient rehabilitation for neuropathy. This case describes that thiamine deficiency can occur after restrictive bariatric surgery, despite lower risk of malnutrition in the absence of intestinal bypass procedure. This report highlights that in the presence of risk factors: dietary noncompliance, inadequate follow-up, and severe nausea with and without vomiting can precipitate the development of Wernicke's encephalopathy, even after restrictive surgery. Physicians may increasingly encounter thiamine and other nutrient deficiencies in increasing numbers due to increasing prevalence of obesity disorders and availability of bariatric surgeries. This report also emphasized the importance of identifying vague sensory symptoms in thiamine deficiency.

  13. Port site hernia after laparoscopic sleeve gastrectomy: a retrospective cohort study of 352 patients.

    Science.gov (United States)

    Ece, Ilhan; Yilmaz, Huseyin; Alptekin, Husnu; Yormaz, Serdar; Colak, Bayram; Sahin, Mustafa

    2018-03-01

    Port site hernia (PSH) following laparoscopic procedures is a rare but serious complication. The aim of this study was to evaluate the rate of PSH after laparoscopic sleeve gastrectomy (LSG), and the efficacy of closure of the port site as a means of preventing PSH. A retrospective analysis was performed on 386 patients who underwent LSG between December 2009 and January 2015. 352 (91.2%) of the patient were followed up for at least 24 months. In the first 206 patients, the fascial layers of the trocar incisions were not closed, while in the next 146 cases, routine closure of the trocar sites was performed. The patients were reviewed in relation to demographics, comorbidities, complications, percentage of excess weight loss, and rates of PSH. The total cohort consisted of 220 female and 132 male patients with a mean age of 36.2 ± 12.3 years. Demographic data, initial BMI, and comorbidities were similar for the patients in both groups. The closure of the fascia was caused by the prolonged duration of the operation with no significant difference. The unclosed fascial defects were associated with a significantly increased incidence of PSH (1.3 vs. 3.9%, p port sites may result in a decreased PSH rate.

  14. Impact of laparoscopic Roux-en-Y Gastric bypass versus sleeve gastrectomy on postoperative lipid values.

    Science.gov (United States)

    Van Osdol, Andrew D; Grover, Brandon T; Borgert, Andrew J; Kallies, Kara J; Kothari, Shanu N

    2017-03-01

    Metabolic surgery has been shown to significantly improve many obesity-related co-morbidities, including dyslipidemia. The literature has produced mixed results comparing postoperative lipid values after laparoscopic Roux-en-Y gastric bypass (LRYGB) compared to laparoscopic sleeve gastrectomy (LSG); with some indicating significantly greater reductions in total cholesterol and low-density lipoprotein (LDL) in LRYGB versus LSG, and others reporting no significant differences. To evaluate the postoperative lipid values after LRYGB versus LSG at a community hospital. Integrated multispecialty health system with a community teaching hospital. A retrospective review of our prospective database was completed to identify patients who underwent either LRYGB or LSG at our institution from 2001 through 2013. Lipid values available at 6-18 months postoperative were evaluated. Statistical analysis included χ 2 and Wilcoxon rank-sum tests. A P value130 mg/dL (P = .68), respectively. HDL values were within the recommended range in 52% and 57% of LRYGB and LSG patients, respectively (P = .64). Patients who underwent LRYGB had a greater postoperative reduction in total cholesterol, LDL, and triglycerides. LRYGB may be the more appropriate bariatric procedure for patients with significant preoperative hypercholesterolemia. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  15. Health-Related Fitness Improvements in Morbid Obese Patients After Laparoscopic Sleeve Gastrectomy: a Cohort Study.

    Science.gov (United States)

    Gallart-Aragón, Tania; Fernández-Lao, Carolina; Castro-Martín, Eduardo; Cantarero-Villanueva, Irene; Cózar-Ibáñez, Antonio; Arroyo-Morales, Manuel

    2017-05-01

    Laparoscopic sleeve gastrectomy (LSG) has demonstrated high long-term effectiveness and major advantages over other techniques. The objective of this study was to analyze changes in physical fitness parameters in morbidly obese patients during 6 months after LSG. We conducted a descriptive observational study with 6-month follow-up in 72 LSG patients, evaluating changes in body mass index (BMI), functional capacity (6-min walking test), hand grip strength (manual dynamometry), flexibility (fingertip-to-floor test), balance (Flamingo test), physical activity level (International Physical Activity Questionnaire, IPAQ), and perception of general physical fitness (International Fitness Scale [IFIS] questionnaire). The ANOVA revealed significant improvements in BMI, functional capacity, flexibility, balance, and physical activity level (P fitness in most cases. No significant changes were found in dominant hand (P = 0.676) or non-dominant hand (P = 0.222) dynamometry. General physical fitness was positively correlated with BMI and distance in the 6-min test, and was negatively correlated with fingertip-to-floor distance. Morbidly obese patients showed major improvements at 6 months after LSG in functional capacity, balance, mobility, and physical activity, with no change in grip strength. These improvements were related to a better self-perception of general physical fitness.

  16. Markers of Bone Metabolism in Obese Individuals Undergoing Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Schollenberger, Asja E; Heinze, Jaana M; Meile, Tobias; Peter, Andreas; Königsrainer, Alfred; Bischoff, Stephan C

    2015-08-01

    Besides its advantages, bariatric surgery implicates a risk of nutritional deficiencies, which might result in impaired bone metabolism. We assessed the effect of laparoscopic sleeve gastrectomy (LSG) on blood markers of bone metabolism in obese patients during a 3-year observation period. In 39 obese patients (29 women, 10 men, mean BMI 51.8 ± 6.8 kg/m(2)) undergoing LSG, we measured blood concentrations of 25-hydroxyvitamin D (25(OH)D), calcium, parathyroid hormone (PTH), bone alkaline phosphatase (BAP), and N-telopeptides crosslinks (NTx) before LSG and up to 3 years postoperatively. Vitamin D and calcium supplementations were recorded. LSG caused an excess weight loss (EWL) of 54 ± 20 % after 3 years. Before surgery, we found decreased levels of 25(OH)D and calcium in 80 and 5 % of the subjects, respectively, while increased levels of PTH, BAP, and NTx were found in 39, 28, and 21 %, respectively. Mean levels of NTx and the prevalence of elevated levels of NTx increased within 2 years (p postoperatively. Morbid obesity is associated with pronounced changes of markers of bone metabolism; LSG did neither aggravate nor ameliorate vitamin D metabolism within a 3-year time period, but led to increased bone resorption 2 years postoperatively. Routine supplementation of calcium and vitamin D is not likely sufficient to compensate the obesity-associated deficiencies in bone metabolism.

  17. Postoperative pain after conventional laparoscopic versus single-port sleeve gastrectomy: a prospective, randomized, controlled pilot study.

    Science.gov (United States)

    Morales-Conde, Salvador; Del Agua, Isaías Alarcón; Moreno, Antonio Barranco; Macías, María Socas

    2017-04-01

    Laparoscopic approach is the gold standard for surgical treatment of morbid obesity. The single-port (SP) approach has been demonstrated to be a safe and effective technique for the treatment of morbid obesity in several case control studies. Compare conventional multiport laparoscopy (LAP) with an SP approach for the treatment of morbid obesity using sleeve gastrectomy in terms of postoperative pain using a visual analog scale (VAS) 0-100, surgical outcome, weight loss, and aesthetical satisfaction at 6 months after surgery. University Hospital, Spain. Randomized, controlled pilot study. The trial enrolled patients suitable for bariatric surgery, with a body mass index lower than 50 kg/m 2 and xiphoumbilical distance lower than 25 cm. Patients were randomly assigned to receive LAP or SP sleeve gastrectomy. A total of 30 patients were enrolled; 15 were assigned to LAP group and 15 to SP group. No patients were lost during follow-up. Baseline characteristics were similar in both groups. A significantly higher level of pain during movement was noted for the patients in the LAP group on the first (mean VAS 49.3±12.2 versus 34.1±8.9, P = .046) and second days (mean VAS 35.9±10.2 versus 22.1±7.9, P = .044) but not the third day (mean VAS 20.1±5.2 versus 34.12.9 ±4.3, P = .620). No differences regarding pain at rest, operative time, complications, or weight loss at 6 months were observed. Higher aesthetical satisfaction was noticed in SP group. In selected patients, SP surgery presented less postoperative pain in sleeve gastrectomy compared with the conventional laparoscopic approach with similar surgical results. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  18. Comparison of Early Results and Complications between Multi-and Single-Port Sleeve Gastrectomy: A Randomized Clinical Study

    Directory of Open Access Journals (Sweden)

    Seyed Vahid Hosseini

    2017-05-01

    Full Text Available Background: In recent years, laparoscopic sleeve gastrectomy (LSG has become more acceptable for obese patients. Single-port sleeve gastrectomy (SPSG is more popular since each abdominal incision carries the risk of bleeding, hernia, and internal organ injury as well as exponentially affecting cosmesis. This cross-sectional study aimed at comparing multi-port sleeve gastrectomy (MPSG and SPSG in terms of their early results and complications. Methods: Out of129 obese patients candidated for LSG, 102 patients were assigned to 2 groups of SPSG and MPSG. Complications and demographic data such as body mass index (BMI, age, gender, operation time, and hospital stay were measured. All surgeries were carried out between2013 and 2015 in Shiraz, Iran. Data analysis was performed using SPSS, version 16 for Windows (SPSS Inc., Chicago, IL. The continuous and categorical variables were compared using the Student t-test and the Chi-square test or the Fisher exact test, respectively. Results: The patients’ data from both groups were similar in terms of age, intraoperative and postoperative bleeding volume, and length of hospital stay. Mean BMI was 42.8±0.7 in the SPSG group and 45.3±1.2 in the MPSG group. Duration of surgery was significantly lower in the SPSG group (P<0.001. Only 1 patient from the SPSG group and 5 patients from the MPSG group had bleeding as an early complication. Conclusion: The differences in each complication between the groups were not statistically significant. SPSG seems to be safe and is the same as MPSG in terms of major postoperative complications. Trial Registration Number: IRCT201512229936N12

  19. Changes in Frequency Intake of Foods in Patients Undergoing Sleeve Gastrectomy and Following a Strict Dietary Control.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Bozhychko, Maryana; Del-Campo, Jone Miren; Boix, Evangelina; Zubiaga, Lorea; Muñoz, Jose Luis; Llavero, Carolina

    2017-12-17

    Dietary intake and food preferences change after bariatric surgery, secondary to gastrointestinal symptoms and dietitian counseling. The aim of this study was to evaluate the changes in the frequency intake of different foods in patients undergoing sleeve gastrectomy and following a strict dietary control. A prospective observational study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between 2007 and 2012 was performed. Dietary assessment was performed using the Alimentary Frequency Questionnaire 1991-2002, developed and validated by the Department of Epidemiology of Miguel Hernandez University (Elche, Alicante Spain). Ninety-three patients were included for analysis, 73 females and 20 males, with a mean preoperative BMI of 46.4 ± 7.9 kg/m 2 . One year after surgery, excess weight loss was 81.1 ± 8.3% and 5 years after surgery, 79.9 ± 6.4%. Total weight loss at 1 year was 38.8 ± 5.3% and at 5 years, 35.4 ± 4.9%. Postoperatively, a reduction in the intake of dairy products, red meat, deli meat products, shellfish, fried potatoes, sweets, rice, pasta, beer, and processed foods was observed. Vegetables, fruits, and legumes intake increased after surgery. In the first postoperative year, there was a slight intolerance to red meat, fruits, vegetables and legumes, dairy products, pasta, and rice that mostly disappeared 5 years after surgery. One year after sleeve gastrectomy, calibrated with a 50-French bougie, there are not important problems in the intake of foods a priori difficult to digest. These problems mostly disappeared 5 years after surgery. The decrease intake of other unhealthy foods is mostly based on the dietary counseling.

  20. [Prospective study of gluco-lipidic hormone and peptide levels in morbidly obese patients after sleeve gastrectomy].

    Science.gov (United States)

    Bruna, Marcos; Gumbau, Verónica; Guaita, Marcos; Canelles, Enrique; Mulas, Claudia; Basés, Carla; Celma, Isabel; Puche, José; Marcaida, Goitzane; Oviedo, Miguel; Vázquez, Antonio

    2014-03-01

    Different hormones and peptides involved in lipid and carbohydrate metabolism have been studied in relation to morbid obesity and its variation after bariatric surgery. The aim of this study is toevaluate variations in different molecules related to glico-lipidic metabolism during the first year after sleeve gastrectomy in morbidly obese patients. Prospective study in patients undergoing sleeve gastrectomy between November 2009 and January 2011. We analyzed changes in different clinical, anthropometric and analytic parameters related with glico-lipidic metabolism in all patients in the preoperative period, first postoperative day, fifth day, one month, 6 months and one year after surgery. Statistical analysis was performed using SPSS 20.0. We included 20 patients, 60% were women with a median of age of 45 years. Median of body mass index (IMC) was 48,5 kg/m(2) and 70% had obstructive sleep apnea syndrome (SAOS), 65% arterial hypertension (HTA), 45% dyslipidemia and 40% diabetes mellitus. One year after surgery, the percentage of excess of BMI loss was 72% and the rate of cure or improvement of dyslipidemia was 100%, diabetes 87,5%, HTA 84,6% and SAOS 57,1%. At this time, glycemia levels decreased significantly (P<.001), and levels of IGF-1 and HDL-cholesterol increased significantly. Levels of adiponectine increased and leptine (P=.003), insulin (P=.004) and triglycerides (P=.016) decreased significantly one year after the surgery. ACTH levels (that decreased during first 6 months after surgery), glycosilated hemoglobin, total cholesterol and LDL-cholesterol had no changes one year after surgery. Sleeve gastrectomy is a surgical technique with good results of weight loss and cure of comorbidities. This procedure induces significant modifications in blood levels of glico-lipidic metabolism related peptides and hormones, such as glucose, IGF-1, insulin, leptin, triglycerides and HDL-cholesterol. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  1. Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass for Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Seki, Yosuke; Kasama, Kazunori; Umezawa, Akiko; Kurokawa, Yoshimochi

    2016-09-01

    Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB), which has been positioned as a novel bariatric procedure, is the combination of vertical sleeve gastrectomy and proximal intestinal bypass and is theoretically expected to have strong anti-diabetic effect. Also, preserving the pylorus, a physiological valve, leads to less occurrence of dumping syndrome and anastomotic stenosis which are often problematic after laparoscopic Roux-en-Y gastric bypass (LRYGB), a gold standard. The purpose of this study was to investigate the clinical effects of LSG-DJB on obese patients with type 2 diabetes mellitus (T2DM). Consecutive 75 obese patients (female 44/male 31) associated with T2DM who underwent LSG-DJB and were followed up for at least 1 year were analyzed. The mean age was 45.5 ± 8.6 years, and the mean preoperative body weight (BW) and body mass index (BMI) were 108.4 ± 21.4 kg and 39.6 ± 7.3 kg/m(2), respectively. The mean hemoglobin A1c (HbA1c) at the first visit was 9.0 ± 1.9 %, and the duration of T2DM from diagnosis was 7.2 ± 6.2 years. Thirty-six out of the 75 patients (48 %) were treated with insulin preoperatively. All patients were evaluated and managed under a strict multidisciplinary team approach. The follow-up rate at 1 year was 89 %. At 1 year, the mean BW and BMI significantly dropped to 74.6 ± 16.9 kg and 27.5 ± 5.7 kg/m(2), respectively. The mean percent of excess weight loss (%EWL) and percent of total body weight loss (%TWL) were 99.4 ± 42.4 and 31.6 ± 8.8 %, respectively. Consequently, 68.7 % of the patients achieved HbA1c less than 6 %, and 82.1 % of them achieved HbA1c less than 6.5 % without diabetes medications. Glycemic control of HbA1c less than 7 % was achieved in 91.0 % of the patients. The percentage of patients who satisfied the American Diabetes Association (ADA)-defined composite endpoints for cardiovascular disease (CVD) risk factor control increased from 0

  2. Early Weight Recidivism Following Laparoscopic Sleeve Gastrectomy: A Prospective Observational Study.

    Science.gov (United States)

    Fahmy, Mohamed H A; Sarhan, Mohamed D; Osman, Ayman M A; Badran, Ahmad; Ayad, Amr; Serour, Dalia K; Balamoun, Hany A; Salim, Mohamed E

    2016-11-01

    Although weight loss following laparoscopic sleeve gastrectomy (LSG) can be substantial, weight recidivism is still a major concern. The aim of our work is to study early weight recidivism following LSG and to evaluate the role of gastric computed tomography volumetry (GCTV) in the assessment of patients experiencing early weight regain. One-hundred and one morbidly obese patients undergoing LSG were prospectively studied. Patients were followed up for 2 years. Those who presented with weight recidivism were counseled for dietary habits and assessed for the amount of weight regain. Patients who regained weight were scheduled for GCTV. Twelve patients were excluded from the study. Weight recidivism was reported in 9/89 patients (10.1 %) [weight loss failure (n = 1), weight regain (n = 8)] and was almost always first recognized 1½-2 years after LSG. The amount of weight regain showed negative correlations with preoperative body weight and body mass index (r = -0.643, P = 0.086 and r = -0.690, P = 0.058; respectively) and positive correlations with the distance between the pylorus and the beginning of the staple line (r = 0.869, P = 0.005), as well as with the residual gastric volume (RGV) on GCTV 2 years after LSG (r = 0.786, P = 0.021). In the small group of patients who regained weight, a longer distance between the pylorus and the beginning of the staple line, as well as a higher RGV on GCTV 2 years after LSG, were both associated with increased weight regain. Gastric computed tomography volumetry with RGV measurement holds promise as a useful research tool after LSG.

  3. Over-Sewing of Staple Line in Laparoscopic Sleeve Gastrectomy: Initial Experience of a Comparative Study.

    Science.gov (United States)

    Lisi, Giorgio; Rossini, Roberto; Gentile, Irene; Ruffo, Giacomo

    2017-10-12

    The main drawback of laparoscopic sleeve gastrectomy (LSG) is the severity of postoperative complications. Staple line reinforcement (SLR) is strongly advocated. Recently, over-sewing has been proposed as a cost-effective and helpful method for reinforcing the staple line. The purpose of this study was to report our initial experience with LSG comparing over-sewing over the entire staple line with the upper-third staple line. All obese patients seen at Negrar Sacro Cuore, Don Calabria Hospital were entered into our prospective database and were retrospectively evaluated. Complications (divided as major complications: leaks and bleeding; and minor complications: dysphagia, esophagitis, and reflux disease) and reoperations were recorded for all patients. Complications were graded according to the Clavien classification system. From February 2015 to March 2016, 30 patients underwent LSG. Patients were divided in two groups according to over-sewing: Group A-over-sewing over the entire staple line; and Group B upper-third over-sewing. Mean total operative time was longer in Group A-90 minutes-compared with 85 minutes in Group B. In regard to minor complications, we reported one esophagitis and two cases of dysphagia in Group B and one dysphagia in Group A. Gastroesophageal reflux was higher in Group B than in Group A (3 vs. 1, p=0.149). Three major complications were observed (10%): two bleeding and one hematoma in Group B and no major complications occurred in Group A. All major complications were conservatively treated. No leaks were reported in both groups. No mortality was observed. Over-sewing of the staple line was associated with fewer leaks but no conclusions can be drawn regarding the effects of over-sewing on staple line bleedings. Before standardizing surgical techniques further, trials are necessary to improve our knowledge about over-sewing in LSG.

  4. Sweet Eating Habit: Does This Affect the Results After Sleeve Gastrectomy?

    Science.gov (United States)

    Moser, Federico; Marconetto, Mariana; Gorodner, Verónica; Viscido, Germán; Piazzoni, Noel; Maldonado, Pablo; Rodriguez, Eugenia Loretani; Obeide, Lucio

    2016-04-01

    It is commonly believed that eating habits, specially the sweet eating habit, can predict results after bariatric surgery; for this reason, it is considered one of the selection criteria when deciding the surgical technique. However, there is not enough evidence of its impact on the results after sleeve gastrectomy (SG). To evaluate the relationship between the sweet eating habit and weight loss after SG. Cross-sectional retrospective study. Group A: nonobese subjects, and group B: patients who underwent SG and had ≥6 months follow-up. Demographics, anthropometrics, percentage excess weight loss (%EWL) at 6, 12, and 24 months, and eating habits before surgery were analyzed. Sweet eating consumption was classified as follows: mild, moderate, and severe. Uni- and bivariate logistic regression analysis according to each variable was performed. Between 2006 and 2011, 157 patients underwent SG at our institution; 36% were male, age 41 years old, and initial body mass index 46 kg/m(2). Mean %EWL at 6, 12, and 24 months was 66%, 77%, and 70%, respectively. Sweet eating consumption: Mild: 59%; Moderate: 38%; and Severe: 3%. No difference was found in sweet eating patterns among groups A and B; %EWL for mild, moderate, and severe sweet eaters at 6 months was 66 ± 16, 66 ± 14, and 65 ± 10, respectively (P = non-significant [NS]). The same analysis was made at 12 months: 76 ± 20, 79 ± 18, and 78 ± 11 (P = NS). At 24 months, only mild and moderate sweet eaters were available for comparison: 69 ± 23 and 73 ± 19, respectively (P = NS). Preliminary data suggested that preoperative sweet eating habit would not predict results after SG in terms of weight loss.

  5. Micronutrient and Protein Deficiencies After Gastric Bypass and Sleeve Gastrectomy: a 1-year Follow-up.

    Science.gov (United States)

    Verger, Eric O; Aron-Wisnewsky, Judith; Dao, Maria Carlota; Kayser, Brandon D; Oppert, Jean-Michel; Bouillot, Jean-Luc; Torcivia, Adriana; Clément, Karine

    2016-04-01

    Roux-en-Y gastric bypass (GBP) and sleeve gastrectomy (SG) have increased dramatically, potentially increasing the prevalence of nutritional deficiencies. The aim of this study was to analyze the effects of food restriction during the first year after bariatric surgery (BS) on nutritional parameters. Twenty-two and 30 obese patients undergoing GBP and SG were prospectively followed at baseline and 3, 6, and 12 months after BS (N = 14 and N = 19 at T12). We evaluated food intake and nutrient adequacy (T0, T3, T12), as well as serum vitamin and mineral concentration (T0, T3, T6, T12). At baseline, GBP and SG patients had similar clinical characteristics, food intake, nutrient adequacy, and serum concentration. The drastic energy and food reduction led to very low probabilities of adequacy for nutrients similar in both models (T3, T12). Serum analysis demonstrated a continuous decrease in prealbumin during the follow-up, indicating mild protein depletion in 37 and 38% of GBP patients and 57 and 52% of SG patients, respectively, at T3 and T12. Conversely, despite the low probabilities of adequacy observed at T3 and T12, systematic multivitamin and mineral supplementation after GBP and SG prevented most nutritional deficiencies. GBP and SG have comparable effects in terms of energy and food restriction and subsequent risk of micronutrient and protein deficiencies in the first year post BS. Such results advocate for a cautious monitoring of protein intake after GPB and SG and a systematic multivitamin and mineral supplementation in the first year after SG.

  6. Evaluation of Vitamin and Trace Element Requirements after Sleeve Gastrectomy at Long Term.

    Science.gov (United States)

    Pellitero, Silvia; Martínez, Eva; Puig, Rocío; Leis, Alba; Zavala, Roxanna; Granada, María Luisa; Pastor, Cruz; Moreno, Pau; Tarascó, Jordi; Puig-Domingo, Manel

    2017-07-01

    Nutritional deficiencies are common after bariatric surgery, but data are scarce after sleeve gastrectomy (SG) at long term. We performed a prospective nutritional status evaluation before and at 2 and 5 years after SG in morbid obese patients receiving mulvitamin and mineral supplementation at a Spanish university hospital. One hundred seventy-six patients (49.3 ± 9.1 years and 46.7 ± 7.4 kg/m 2 ) were evaluated; 51 of them were followed during 5 years. Anthropometric, compliance supplementation intake, and micronutrient evaluation were performed. Baseline concentrations were below normal values for 25(OH) vitamin D (73%), folic acid (16.5%), cobalamin (6.9%), pyridoxine (12%), thiamine (3.4%), and copper (0.5%). Anemia was found in 23%. In 49% of the subjects, at least one micronutrient deficiency was found at 2 years after SG. Vitamin D deficiency persisted at 2 and 5 years higher than 30% of patients. Frequencies of deficiencies for folic acid, B12, B6, and B1 vitamins decreased significantly after 2 years with normalization at 5 years. Copper deficiency increased between 1 and 2 years and it persisted at 5 years after SG. Vitamin supplementation compliance decreased progressively from the first year after surgery (94.8 to 81% at 2 years and to 53% 5 years after surgery). Vitamin D deficiency is the most prevalent long-term nutritional deficiency after SG. About half of patients show some micronutrient deficiency at medium long term, despite supplementation. A proactive follow-up is required to ensure a personalized and adequate supplementation in all surgically treated obese patients including those in which SG has been performed.

  7. Over-the-Scope Clip (OTSC) System for Sleeve Gastrectomy Leaks.

    Science.gov (United States)

    Keren, D; Eyal, O; Sroka, G; Rainis, T; Raziel, A; Sakran, N; Goitein, D; Matter, I

    2015-08-01

    Laparoscopic sleeve gastrectomy (LSG) is currently being widely accepted for its role in the treatment of morbid obesity. Staple-line leakage is one of the most reported complications found in 0.5-7 % of the population, in which the Over-the-Scope Clip (OTSC) (Ovesco Endoscopy, Tübingen, Germany), a novel device, is employed. We present our experience with this system in LSG leaks. A retrospective analysis of prospectively collected data from patients with LSG leakage was performed, and these patients were treated with the OTSC system. Efficiency was defined as complete oral nutrition without any evidence of additional leakage. Overall, 26 patients underwent endoscopic OTSC treatment. The median age was 39 years (range 26-60), and 12 were male patients (46.15 %). The mean body mass index (BMI) was 42.89 kg/m(2), and 10 patients (38.46 %) came from a revisional bariatric procedure (SRVG or LAGB). Twenty-two patients (84.61 %) had upper staple-line leaks (near the GEJ), and the remaining 4 (15.38 %) had lower antral leaks. Number of endoscopy sessions ranged from 2 to 7 (median 3). There were five failures: 2 of them had an antral leak, and the remaining 3 had an upper staple-line leak. Twenty-one (80.76 %) leaks were successfully treated within 32 days' median time till complete oral nutrition was attained (range 14-70). The success rate was high with the OTSC system, and it is concluded to be a safe and effective treatment for LSG leaks.

  8. Minimizing Hemorrhagic Complications in Laparoscopic Sleeve Gastrectomy--a Randomized Controlled Trial.

    Science.gov (United States)

    Sroka, Gideon; Milevski, Daria; Shteinberg, Dan; Mady, Husam; Matter, Ibrahim

    2015-09-01

    Laparoscopic sleeve gastrectomy (LSG) has gained worldwide popularity in recent years. Hemorrhagic complications (HC) are usually the result of stapler line bleeding and are probably underreported. The previous incidence of HC in our department including minor bleeding and late hematomas was 15.0 %. The objective of this study is to assess the impact of stapler line reinforcement (SLR) and intraoperative blood pressure control on HC after LSG. Between February 2013 and March 2014, patients who were admitted to our department for LSG were randomly assigned to one of three arms: stapler line application of biologic glue--Evicel™ (E), over suture of the stapler line (S) or control (C). Surgical technique in all arms included blood pressure elevation to 140 mmHg before termination of the procedure. Data is presented as mean ± SD or median (IQR 25-75). One hundred sixty-five patients were randomized: 49 to E, 49 to S, and 67 to C. There were no demographic differences between arms. Operative time was significantly longer in S than in E and C arms (74 ± 21 vs. 64 ± 23 and 54 ± 19 min, respectively). ∆Hb was significantly lower in the S group. Packed cells were used in two from E and one from C arms. Late infected hematoma occurred in three (1.8 %) patients: one from E and two from C arms. Leak rate was 1.2 %: one from S and one from C arms. LOS was the same. No patients were re-operated due to bleeding. In this randomized trial, routine elevation of systolic blood pressure to 140 mmHg and over suture of the staple line in LSG minimized HC, with reasonable prolongation of the procedure.

  9. Sleeve gastrectomy leads to weight loss in the Magel2 knockout mouse.

    Science.gov (United States)

    Arble, Deanna M; Pressler, Joshua W; Sorrell, Joyce; Wevrick, Rachel; Sandoval, Darleen A

    2016-12-01

    Prader-Willi syndrome (PWS) is a genetic disorder characterized by hyperphagia, obesity, cardiopulmonary diseases, and increased mortality. Although successful weight loss improves health in PWS, few treatments cause sustained weight loss in obese patients let alone obese individuals with PWS. The present study uses the Magel2 knockout (KO) mouse, an animal model of PWS, to conduct a preclinical study on the efficacy of sleeve gastrectomy (SG) in PWS. Academic research laboratory, United States. We performed sham or SG surgeries in 24- to 28-week-old male Magel2 KO and wild-type littermate control mice (WT) who had been maintained on a high-fat diet for 10 weeks. We monitored weight, food intake, and fat and lean mass pre- and postoperatively. Fasting glucose, glucose tolerance, and counter-regulation were measured postoperatively. Magel2 KO animals had similar recovery and mortality rates compared with WT. SG resulted in similar weight loss, specifically loss of fat but not lean mass, in both Magel2 KO and WT mice. SG also resulted in significantly lower fasting glucose levels and a reduction in fat intake in both Magel2 KO and WT mice. We also found that Magel2 KO mice failed to increase their food intake in response to the glucoprivic agent 2-deoxy-D-glucose, suggesting impaired glucose counter-regulation, but this occurred regardless of surgical status. All results were considered significant when P< .05. We find in this mouse model of PWS, SG is a well-tolerated, effective strategy for weight and fat loss. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  10. Diet Change After Sleeve Gastrectomy Is More Effective for Weight Loss Than Surgery Only.

    Science.gov (United States)

    Rossell, Joana; González, Marta; Mestres, Núria; Pardina, Eva; Ricart-Jané, David; Peinado-Onsurbe, Julia; Baena-Fustegueras, Juan Antonio

    2017-10-01

    Bariatric surgery with or without diet change has become one of the most effective treatments for obesity. The objective of this study was to observe the effects of vertical sleeve gastrectomy (VSG) and diet change in Sprague-Dawley rats on both body and tissue weights. Eighteen rats were fed with a standard chow diet (SCD) (C group), and 36 rats were fed with a high-fat diet (HFD) (diet-induced obesity (DIO) group). After 8 weeks, the animals underwent VSG, sham surgery or no surgery (NS). After surgery, a third of the rats fed with the HFD changed to the SCD (DIO + C group). Body weight, food and energy intake were recorded daily during the experiment (12 weeks). Food efficiency (%) (FE) was determined from weekly weight gain and weekly kilocalorie consumed measurements. The DIO group had higher and significant weight gain than the C group at the time of surgery (p weight loss (WL) was observed in the DIO + C-VSG group, during the 4 weeks after surgery. Adipose tissues in the DIO + C-VSG group were drastically reduced and had a weight similar to those in the C-VSG group. VSG and the diet change combination led to a greater WL, which was maintained during the 4 weeks post-surgery, leading to a normalization of body weight. VSG and diet change also affected most of the tissues, not only adipose, showing a global change in whole body composition.

  11. Nutritional deficiencies four years after laparoscopic sleeve gastrectomy-are supplements required for a lifetime?

    Science.gov (United States)

    Ben-Porat, Tair; Elazary, Ram; Goldenshluger, Ariela; Sherf Dagan, Shiri; Mintz, Yoav; Weiss, Ram

    2017-07-01

    Data regarding long-term nutritional deficiencies following laparoscopic sleeve gastrectomy (LSG) are scarce. To assess the prevalence of nutritional deficiencies and supplement consumption 4 years post-LSG. Hebrew University, Israel. Data were collected prospectively from preoperative and 1 and 4 years postoperative including anthropometric parameters, biochemical tests, and supplement intake. Data were available for 192, 77, and 27 patients at presurgery and 1 and 4 years post-LSG, respectively. Prevalence of nutritional deficiencies at baseline and 1 and 4 years postsurgery, respectively, were specifically for iron (44%, 41.2%, 28.6%), anemia (11.5%, 20%, 18.5%), folate (46%, 14.3%, 12.5%), vitamin B12 (7.7%, 13.6%, 15.4%), vitamin D (96.2%, 89%, 86%), and elevated parathyroid hormone (PTH) (52%, 15.4%, 60%). Vitamin D levels remained low throughout the whole period. PTH levels were 37.5 pg/mL at 1 year postsurgery and increased to 77.3 pg/mL at 4 years postsurgery (P = .009). Females had higher prevalence of elevated PTH and a tendency for higher rates of anemia, compared with males 4 years postsurgery (80% versus 20%, P = .025; and 28% versus 0%, P = .08, respectively). Of the patients, 92.6% reported taking a multivitamin and 74.1% vitamin D supplements during the first postoperative year, while after 4 years only 37% and 11.1% were still taking these supplements, respectively. A high rate of nutritional deficiencies is common at 4 years post-LSG along with low adherence to the nutritional supplementation regimen. Long-term nutritional follow-up and supplementation maintenance are crucial for LSG patients. Future studies are needed to clarify the clinical impact of such deficiencies. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  12. Preoperative Detection of Sarcopenic Obesity Helps to Predict the Occurrence of Gastric Leak After Sleeve Gastrectomy.

    Science.gov (United States)

    Gaillard, Martin; Tranchart, Hadrien; Maitre, Sophie; Perlemuter, Gabriel; Lainas, Panagiotis; Dagher, Ibrahim

    2018-03-02

    Sleeve gastrectomy (SG) has become the primary procedure for many bariatric teams and staple-line leak represents its most feared complication. Sarcopenic obesity combines the risks of obesity and depleted lean mass leading possibly to an inferior surgical outcome after abdominal surgery. The aim of this study was to evaluate the existence of a potential link between radiologically determined sarcopenic obesity and staple-line leak risk after SG. A retrospective analysis of a prospective database was performed in consecutive patients undergoing SG as primary procedure. Total psoas muscles (TPA) and total visible muscles (TMA) areas were measured on a preoperative computed tomography (CT). Sarcopenia was defined as lowest tertile of skeletal muscular mass indexes (muscular areas over square of height) in each gender (using TPA or TMA). Multivariate analysis was performed to determine preoperative risk factors for staple-line leak. During the study period, 205 patients were included in the analysis. Median BMI was 40.8 kg/m 2 (34.2-49.6), and 9 patients (4.4%) presented a gastric leak. The sex-specific cut-offs for skeletal muscular mass index according to TPA were 8.2 cm 2 /m 2 for men and 6.08 cm 2 /m 2 for women. After multivariate analysis, preoperative weight (OR = 1043) and sarcopenia (TPA) (OR = 5204) were independent predictive factors for gastric leak. The present series suggests that CT scan-determined sarcopenic obesity is associated with increased risk of gastric leak after SG. This preoperatively radiological examination would be a useful clinical tool to tailor patient management according to gastric leak risk.

  13. Barium swallow for hiatal hernia detection is unnecessary prior to primary sleeve gastrectomy.

    Science.gov (United States)

    Goitein, David; Sakran, Nasser; Rayman, Shlomi; Szold, Amir; Goitein, Orly; Raziel, Asnat

    2017-02-01

    Hiatal hernia (HH) is common in the bariatric population. Its presence imposes various degrees of difficulty in performing laparoscopic sleeve gastrectomy (LSG). Preoperative upper gastrointestinal evaluation consists of fluoroscopic and or endoscopic studies OBJECTIVES: To evaluate the efficacy of routine, preoperative barium swallow in identifying HH in patients undergoing LSG, and determine if such foreknowledge changes operative and immediate postoperative course regarding operative time, intraoperative adverse events, and length of hospital stay (LOS). In addition, to quantify HH prevalence in these patients and correlate preoperative patient characteristics with its presence. High-volume bariatric practice in a private hospital in Israel METHODS: Retrospective analysis of prospectively collected data between October 2010 and March 2015: anthropometrics, co-morbidities, previous barium swallow, preoperative HH workup (type and result), operative and immediate postoperative course. Primary LSG was performed in 2417 patients. The overall prevalence of HH was 7.3%. Preoperative diagnosis of gastroesophageal reflux disease and female gender were independent risk factors for HH presence. Operative times were significantly longer when HH was concomitantly repaired but "foreknowledge" thereof did not assist in shortening this time. Looking for an HH that was suggested in preoperative upper gastrointestinal evaluation slightly prolonged surgery. LOS was not changed in a significant fashion by HH presence and repair, whether suspected or incidentally found. Routine, pre-LSG barium swallow does not seem to offer an advantage over selective intraoperative hiatal exploration, in the discovery and management of HH. Conversely, when preoperative workup yields a false-positive result, surgery is slightly prolonged. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  14. Impact of sleeve gastrectomy on gastroesophageal reflux disease in a morbidly obese population undergoing bariatric surgery.

    Science.gov (United States)

    Hendricks, LéShon; Alvarenga, Emanuela; Dhanabalsamy, Nisha; Lo Menzo, Emanuele; Szomstein, Samuel; Rosenthal, Raul

    2016-01-01

    Laparoscopic sleeve gastrectomy (LSG) has established popularity as a weight loss procedure based on its success. However, LSG's effect on gastroesophageal reflux disease (GERD) is unknown. To analyze the incidence of GERD after LSG and to compare the results in patients with preexisting and de novo GERD. Tertiary Medical center. The authors performed a retrospective review of primary LSG from 2005 to 2013 and compared patients with pre-existing and de novo GERD who underwent LSG. A total of 919 patients underwent LSG. GERD was present in 38 (4%) of the LSG cohort. We identified 2 groups: Group A consisted of 25 (3%) patients with de novo GERD, and Group B consisted of 13 (1%) patients with pre-existing GERD. Diagnosis of GERD in both groups was determined by symptoms and history of proton pump inhibitor (PPI) treatment, upper gastrointestinal endoscopy, esophagogastroduodenoscopy, and pH manometry. In Group A, 1 (4%) patient was managed with over-the-counter drugs, 17 (68%) patients were treated with low-dose PPI, 6 (24%) patients were treated with high-dose PPI, and 1 (4%) patient was lost to follow-up. Group B consisted of 9 (69%) patients treated with low-dose PPI and 4 (31%) patients treated with high-dose PPI. Medical treatment failed in 4 patients (10.5%) who subsequently required conversion to laparoscopic Roux-en-Y gastric bypass (LRYGB). In Group A, 1 patient (4%) required LRYGB, and in Group B, 3 patients (23%) required LRYGB. The outcome of conversion for Group A was incomplete resolution of symptoms in the 1 patient, whereas in Group B, all 3 patients (100%) had complete resolution of GERD symptoms after LRYGB. In this study, 3% of patients developed de novo GERD, but most responded to either low- or high-dose PPI, with 4% requiring conversion to LRYGB. Copyright © 2016 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  15. Long-term outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure.

    Science.gov (United States)

    Boza, Camilo; Daroch, David; Barros, Diego; León, Felipe; Funke, Ricardo; Crovari, Fernando

    2014-01-01

    Laparoscopic sleeve gastrectomy (LSG) has been established as a reliable bariatric procedure, but questions have emerged regarding its long-term results. Our aim is to report the long-term outcomes of LSG as a primary bariatric procedure. Retrospective analysis of patients submitted to LSG between 2005 and 2007 in our institution. Long-term outcomes at 5 years were analyzed in terms of body mass index (BMI), excess weight loss (EWL) and co-morbidities resolution. Surgical success was defined as %EWL>50%. Also, we compared long-term results according to preoperative BMI, using Mann-Whitney test. A total of 161 LSG were analyzed, and 114 patients (70.8%) were women. The median age was 36 years old (range 16-65), median preoperative BMI was 34.9 kg/m(2) (interquartile range [IQR], 33.3-37.5). A total of 112 patients (70%) completed 5 years of follow-up. At the fifth year, median BMI and %EWL was 28.5 kg/m(2) (IQR: 25.8-31.9) and 62.9% (IQR: 45.3-89.6), respectively, with a surgical success of 73.2% of followed patients. According to preoperative BMI, surgical success was achieved in 80% of patients with BMI40 kg/m(2), with significant lower %EWL in patients with BMI>40 kg/m(2) (P = .001 and .004). Dyslipidemia and insulin resistance resolution was 80.7% and 84.7%, respectively. A total of 26.7% of patients reported new-onset gastroesophageal reflux symptoms at 5 years. LSG as a primary procedure is a reliable surgery. We observed positive long-term outcomes of %EWL and co-morbidities resolution. In our series, best results are seen in patients with preoperative BMI<40 kg/m(2). Copyright © 2014. Published by Elsevier Inc.

  16. Laparoscopic sleeve gastrectomy for type 2 diabetes mellitus: predicting the success by ABCD score.

    Science.gov (United States)

    Lee, Wei-Jei; Almulaifi, Abdullah; Tsou, Ju Juin; Ser, Kong-Han; Lee, Yi-Chih; Chen, Shu-Chun

    2015-01-01

    Laparoscopic sleeve gastrectomy (LSG) is becoming a primary bariatric surgery for obesity and related diseases. This study presents the outcome of LSG with regard to the remission of type 2 diabetes mellitus (T2 DM) and the usefulness of a grading system to categorize and predict outcome of T2 DM remission. A total of 157 patients with T2 DM (82 women and 75 men) with morbid obesity (mean body mass index 39.0±7.4 kg/m(2)) who underwent LSG from 2006 to 2013 were selected for the present study. The ABCD score is composed of the patient's age, body mass index, C-peptide level, and duration of T2 DM (yr). The remission of T2 DM after LSG was evaluated using the ABCD score. At 12 months after surgery, 85 of the patients had complete follow-up data. The weight loss was 26.5% and the mean HbA1c decreased from 8.1% to 6.1%. A significant number of patients had improvement in their glycemic control, including 45 (52.9%) patients who had complete remission (HbA1csurgery had a higher ABCD score than those who did not (7.3±1.7 versus 5.2±2.1, Prate of success in T2 DM remission (from 0% in score 0 to 100% in score 10). LSG is an effective and well-tolerated procedure for achieving weight loss and T2 DM remission. The ABCD score, a simple multidimensional grading system, can predict the success of T2 DM treatment by LSG. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  17. Comparison of bariatric restrictive operations: laparoscopic sleeve gastrectomy and laparoscopic gastric greater curvature plication.

    Science.gov (United States)

    Broderick, Ryan C; Fuchs, Hans F; Harnsberger, Cristina R; Sandler, Bryan J; Jacobsen, Garth R

    2014-11-01

    Morbid obesity continues to increase in prevalence, becoming a major socioeconomic and medical problem. The success in treating morbid obesity with surgery has been well documented. The categories of surgical treatment include restrictive, malabsorptive, and combination operations. Two of the restrictive operations at the forefront of today's treatments are laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric greater curvature plication (LGCP). A literature review has been completed to compare the current technique and results for LSG and LGCP. LSG is a restrictive technique in which reduced gastric volume is achieved by partial greater curvature resection. The benefits of LSG include ease of operation, sustainable weight loss, and low complication rate. The disadvantages include risk for severe complications such as gastric leak and bleeding. LGCP is a novel restrictive technique which reduces gastric volume by plication of the greater curvature; it is still in the investigational stages for use in the United States. A gastric tube is formed with the plication, but no portion of the stomach is excised. The benefits of LGCP include low cost, low risk of complication, such as gastric perforation and bleeding, as well as adequate short term weight loss. The disadvantages include higher risk of nausea and vomiting post-op, a non-zero risk of perforation and bleeding, and likely an unsustainable weight loss. In comparison, LGCP is considered feasible and safe in the short term and especially suited for institutions requiring lower-cost procedures. However, LGCP weight loss may be unsustainable compared to LSG. While LSG complication rates are slightly higher, LGCP is an inferior restrictive procedure for weight loss. Further studies are needed to evaluate the long term outcomes for procedural comparison.

  18. A Randomized Comparison Between Staple-Line Oversewing Versus No Reinforcement During Laparoscopic Vertical Sleeve Gastrectomy.

    Science.gov (United States)

    Taha, Osama; Abdelaal, Mahmoud; Talaat, Mohamed; Abozeid, Mohamed

    2018-01-01

    Varieties of intraoperative methods such as oversewing of staple lines or other reinforcement products are used for preventing the laparoscopic vertical sleeve gastrectomy (LSG) complications. The aim of this study is to evaluate the complication rates of the gastric stapling alone versus stapling with oversewing invagination of the staple line in the LSG. This is a single-center randomized study, Patients were randomized to two groups, 200 patients underwent LSG without reinforcement of the staple line and 200 patients underwent LSG with oversewing of the staple line. All patients were followed up for 1 year. The data collected prospectively for statistical analysis included demographics, BMI, preoperative comorbidities, operative time, complications, and hospital stay. The overall mean operative age was 33.7 ± 9.4 years and mean BMI was 42.4 ± 4.3 kg/m 2 . Patient baseline characteristics (age, gender, weight, and BMI) and comorbidities were generally a nonsignificant different between the treatment arms. Surgical time was shorter in patients of the nonreinforced group (44.3 ± vs 51.3 ± 4.3 min; p < 0.01) with lower %EWL (73 ± 13.8 vs 80.7 ± 13.6%, p < 0.01). One patient in the nonreinforced group was complicated by gastric leak. The staple-line bleeding rate was significantly lower in patients underwent oversewing of the staple line during LSG (p < 0.05). Oversewing of the staple line during LSG is a nonexpansive and easy method to decrease the incidence and severity of the postoperative bleeding. However, it is time-consuming and should be performed by experienced surgeons to avoid the complications which may occur secondary to the seroserotomy suturing.

  19. Perceived Social Support for Exercise and Weight Loss in Adolescents Undergoing Sleeve Gastrectomy.

    Science.gov (United States)

    Mackey, Eleanor Race; Olson, Alexandra; Merwin, Stephanie; Wang, Jichuan; Nadler, Evan P

    2018-02-01

    Bariatric surgery is an effective treatment for youth with severe obesity. However, outcomes are variable and there remains sparse understanding of predictors of weight loss following surgery. The current study examines the role of adolescent-reported pre-operative social support around exercise, binge eating, and exercise to predict excess body mass index (EBMI) loss from 3 to 12 months post-surgery. Participants were 101 adolescents ages 12-21 (M age = 16.6, SD = 1.8). Pre-operative body mass index (BMI) ranged from 35 to 87 (M = 50.3, SD = 8.6). Structural equation modeling (SEM) was used to evaluate a model of the association of adolescent report of perceived social support for exercise with less binge eating (items from the Eating Disorder Diagnostic Scale) and more self-reported exercise (items from the Youth Risk Behavior Surveillance System). The model was used to predict EBMI loss at 3, 6, 9, and 12 months post-surgery. Social support significantly predicted exercise and demonstrated a trend for predicting binge eating, such that more social support was associated with more exercise and a trend for less binge eating. Binge eating was associated with less EBMI loss. However, there was no association of exercise with EBMI loss. Pre-operative binge eating should be a target for identification and treatment prior to sleeve gastrectomy in adolescents. Although not directly or indirectly associated with EBMI loss, perceived social support around exercise was associated with increased exercise, which may make it a consideration for a target for intervention as well.

  20. Is resected stomach volume related to weight loss after laparoscopic sleeve gastrectomy?

    Science.gov (United States)

    Singh, Jagat Pal; Tantia, Om; Chaudhuri, Tamonas; Khanna, Shashi; Patil, Prateek H

    2014-10-01

    Laparoscopic sleeve gastrectomy (LSG) was initially performed as the first stage of biliopancreatic diversion with duodenal switch for the treatment of super-obese or high-risk obese patients but is now most commonly performed as a standalone operation. The aim of this prospective study was to investigate outcomes after LSG according to resected stomach volume. Between May 2011 and April 2013, LSG was performed in 102 consecutive patients undergoing bariatric surgery. Two patients were excluded, and data from the remaining 100 patients were analyzed in this study. Patients were divided into three groups according to the following resected stomach volume: 700-1,200 mL (group A, n = 21), 1,200-1,700 mL (group B, n = 62), and >1,700 mL (group C, n = 17). Mean values were compared among the groups by analysis of variance. The mean percentage excess body weight loss (%EBWL) at 3, 6, 12, and 24 months after surgery was 37.68 ± 10.97, 50.97 ± 13.59, 62.35 ± 11.31, and 67.59 ± 9.02 %, respectively. There were no significant differences in mean %EBWL among the three groups. Resected stomach volume was greater in patients with higher preoperative body mass index and was positively associated with resected stomach weight. Mean %EBWL after LSG was not significantly different among three groups of patients divided according to resected stomach volume. Resected stomach volume was significantly greater in patients with higher preoperative body mass index.

  1. Sleeve gastrectomy in rats improves postprandial lipid clearance by reducing intestinal triglyceride secretion.

    Science.gov (United States)

    Stefater, Margaret A; Sandoval, Darleen A; Chambers, Adam P; Wilson-Pérez, Hilary E; Hofmann, Susanna M; Jandacek, Ronald; Tso, Patrick; Woods, Stephen C; Seeley, Randy J

    2011-09-01

    Postprandial hyperlipidemia is a risk factor for atherosclerotic heart disease and is associated with the consumption of high-fat diets and obesity. Bariatric surgeries result in superior and more durable weight loss than dieting. These surgeries are also associated with multiple metabolic improvements, including reduced plasma lipid levels. We investigated whether the beneficial effects of vertical sleeve gastrectomy (VSG) on plasma lipid levels are weight independent. VSG was performed on Long-Evans rats with diet-induced obesity. Controls were sham-operated animals who were either pair-fed or ad libitum-fed. We measured fasting and postprandial levels of plasma lipid. To determine hepatic and intestinal triglyceride secretion, we injected the lipase inhibitor poloxamer 407 alone or before oral lipid gavage. (13)C-Triolein was used to estimate postprandial uptake of lipid in the intestine. Rats that received VSG and high-fat diets had markedly lower fasting levels of plasma triglyceride, cholesterol, and phospholipid than obese and lean (pair-fed) controls that were fed high-fat diets. Rats that received VSG had a marked, weight-independent reduction in secretion of intestinal triglycerides. VSG did not alter total intestinal triglyceride levels or size of the cholesterol storage pool nor did it affect the expression of genes in the intestine that control triglyceride metabolism and synthesis. VSG did not affect fasting secretion of triglyceride, liver weight, hepatic lipid storage, or transcription of genes that regulate hepatic lipid processing. VSG reduced postprandial levels of plasma lipid, independently of body weight. This resulted from reduced intestinal secretion of triglycerides following ingestion of a lipid meal and indicates that VSG has important effects on metabolism. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

  2. Surgical standardization to prevent gastric stenosis after laparoscopic sleeve gastrectomy: a case series.

    Science.gov (United States)

    Chang, Po-Chih; Tai, Chi-Ming; Hsin, Ming-Che; Hung, Chao-Ming; Huang, Ivy Ya-Wei; Huang, Chih-Kun

    2017-03-01

    Laparoscopic sleeve gastrectomy (LSG) is accepted as a stand-alone bariatric procedure. A specific and potentially severe complication of LSG is gastric stenosis (GS). Reviewing the treatment and prevention of GS after LSG. University hospital, Taiwan. A retrospective analysis was conducted involving all of the LSG cases (n = 927) at our institution between February 2007 and December 2015. Eight patients (0.8%) with GS were identified in our unit and 1 patient was transferred from another institution with symptomatic GS. The median intervals from initial LSG to the presence of symptoms, endoscopic dilation, and surgical revision were 14±30 days (range, 7-103 days), 21±35.6 days (range, 9-110 days), and 36±473.9 days (range, 11-1185 days), respectively. The majority of stenoses were located at the incisura angularis (8/9 [88.9%]). Among the 9 patients, only 1 responded satisfactorily to repetitive endoscopic dilation and the remaining 8 patients required revisional laparoscopic surgery, including conversion to Roux-en-Y gastric bypass (n = 6), stricturoplasty (n = 1), and Roux-en-Y gastric bypass after failed seromyotomy (n = 1). No patients experienced recurrent symptoms of GS after revisional surgery. In September 2013, we modified our surgical techniques for the subsequent 489 patients and GS did not occur after the change in surgical procedures. A combined treatment modality, endoscopic intervention with and without surgical revision is essential for managing GSs. Based on our own experience, we emphasize the clinical significance of surgical standardization to prevent the occurrence of GS. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  3. Taste and Olfactory Changes Following Laparoscopic Gastric Bypass and Sleeve Gastrectomy.

    Science.gov (United States)

    Zerrweck, Carlos; Zurita, Luis; Álvarez, Guillermo; Maydón, Hernán G; Sepúlveda, Elisa M; Campos, Francisco; Caviedes, Amaya; Guilbert, Lizbeth

    2016-06-01

    Alterations in taste/smell after bariatric surgery have been observed, but few data is available. Some authors documented these changes and their role on weight loss but there is no evidence after laparoscopic sleeve gastrectomy (LSG). Cohort study with patients submitted to laparoscopic gastric bypass (LGBP) and LSG that were asked to participate in a validated survey. The primary objective was to determinate the differences between procedures for taste and smell changes; a demographic and anthropometric analysis were also performed. Secondarily, the relation between food aversion and weight loss was also obtained. Final analysis was based on 154 patients (104 LGBP and 50 LSG). The overall mean time between surgery and questionnaire was 10 ± 6.7 months. Most of the patients (87.6 %) experienced some taste/smell change. There were no differences between procedures for any change, taste or smell change. More patients submitted to LGBP referred that food smelled different (51.9 vs 34 % for the LSG group; p = 0.040). Higher %EWL was observed for patients presenting food aversion (73.3 ± 19.7 vs 65.8 ± 19.4 % for those without aversion; p = 0.046). Based on type of surgery, the LGBP group had the same trend (%EWL of 78.2 ± 17.3 vs 70.4 ± 18.6 % for those without aversion; p = 0.044). The majority of patients presented taste and olfactory changes soon after surgery independently of type of procedure. Patients submitted to LGBP referred more often a different smell in food. Higher %EWL was observed in patients presenting any food aversion, especially in the LGBP group.

  4. Laparoscopic conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: indications and preliminary results.

    Science.gov (United States)

    Iannelli, Antonio; Debs, Tarek; Martini, Francesco; Benichou, Benjamin; Ben Amor, Imed; Gugenheim, Jean

    Laparoscopic sleeve gastrectomy (SG) has gained popularity as a standalone procedure. However, long-term complications are reported, mainly weight loss failure and gastroesophageal reflux disease (GERD). Therefore, demand for revisional surgery is rising. The aim of this study was to report preliminary results within the 2 main indications for laparoscopic conversion of SG to Roux-en-Y gastric bypass (RYGB). University Hospital, France. Data from all patients who underwent laparoscopic conversion from SG to RYGB were retrospectively analyzed as to indications for revisional surgery, weight loss, and complications. Forty patients underwent conversion, 29 cases (72.5%) for weight loss failure and 11 cases for refractory GERD (27.5%). The mean interval from SG to RYGB was 32.6 months (range 8-113). Revisional surgery was attempted by laparoscopy in all cases, and conversion to laparotomy was necessary in 3 patients (7.5%). Mean length of follow-up was 18.6 months (range 9-60) after conversion. Follow-up rate was 100%. Mean percent total weight loss and percent excess weight loss were 34.7% and 64%, respectively, when calculated from weight before SG. Remission rate for GERD was 100%. Improvement was observed for all co-morbidities after conversion. There was no immediate postoperative mortality. The postoperative complication rate was 16.7%. According to the Clavien-Dindo classification, there were 5 grade II and 2 grade IIIa complications. Laparoscopic conversion of SG to RYGB is safe and feasible. In the short term, it appears to be effective in treating GERD and inducing significant additional weight loss and improvement of co-morbidities. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  5. Laparoscopic sleeve gastrectomy versus laparoscopic mini gastric bypass: One year outcomes.

    Science.gov (United States)

    Kansou, Gaby; Lechaux, David; Delarue, Jacques; Badic, Bogdan; Le Gall, Morgan; Guillerm, Sophie; Bail, Jean-Pierre; Thereaux, Jérémie

    2016-09-01

    Sleeve gastrectomy (LSG) and mini gastric bypass (LMGB) was considered as emerging procedures but are now considered for many authors as an alternative of the Roux-Y gastric bypass because of similar percentages of weight loss and better postoperative morbidity profiles. However, studies comparing LSG and LMGB are scarce. From January 2010 to July 2014, 262 and 161 patients underwent LSG or LMGB in two centre of bariatric surgery, respectively. At one year, rate of follow-up was 88.4%. Main outcome was % of Total Weight Loss (%TWL) at one year. Propensity score matching and multivariable analyses were used to compensate for differences in some baseline characteristics. After matching LSG (N = 136) and LMGB (N = 136) groups did not differ for initial BMI (kg/m(2)) (43.4 ± 6.5 vs. 42.8 ± 5.0; P = 0.34), % of female patients (91.9% vs. 93.4%; P = 0.64), age (years) (41.2 ± 12.3 vs. 41.2 ± 11.3; P = 0.99) and diabetes (15.4% vs. 19.9%; P = 0.34). At one year, %TWL, change in BMI and rate of stenosis were higher for LMGB group, respectively: 38.2 ± 8.4 vs. 34.3 ± 8.4 (P gastric complications. Further long term studies are needed. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  6. Risk factors for complications of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass.

    Science.gov (United States)

    Major, Piotr; Wysocki, Michał; Pędziwiatr, Michał; Pisarska, Magdalena; Dworak, Jadwiga; Małczak, Piotr; Budzyński, Andrzej

    2017-01-01

    Although bariatric procedures are considered safe, yet still they involve a risk of possible perioperative complications. Identification of risk factors for complications would allow for appropriate preoperative optimization of the patient, as well as reasonable postoperative care and early diagnosis and treatment of possible complications. The aim of this study was to determine the risk factors for perioperative complications after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). A retrospective analysis of prospectively collected data of patients operated for morbid obesity. Regarding postoperative complications defined as adverse events occurring within 30 days of the procedure. Factors associated with patient characteristics and those related to the surgical procedure were determined. 408 patients met inclusion criteria and were submitted to surgical treatment. LSG and LRYGB were performed in 233 and 175 patients, respectively. Complications were observed in 30 (7.3%) patients. The maximum preoperative body weight and BMI, as well as body weight and BMI on the day of surgery were associated with increased complication rate. The type of the procedure did not influence perioperative complications (LRYGB vs. LSG; OR: 1.14; CI: 0.53-2.44; p = 0.74). Although operative time statistically significantly increased the risk of complications, it did not seem clinically relevant (OR: 1.01; CI: 1.00-1.02; p = 0.003). An increase in the number of stapler firings used significantly increased complication rate only in LSG group. Longer duration of LSG and the increase in the number of stapler firings used during LSG should alert a surgeon to an increased risk of postoperative complications. In patients submitted to LRYGB the risk of possible complications increases with BMI. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  7. Vertical sleeve gastrectomy reduces blood pressure and hypothalamic endoplasmic reticulum stress in mice

    Directory of Open Access Journals (Sweden)

    Anne K. McGavigan

    2017-03-01

    Full Text Available Bariatric surgery, such as vertical sleeve gastrectomy (VSG, causes remarkable improvements in cardiometabolic health, including hypertension remission. However, the mechanisms responsible remain undefined and poorly studied. Therefore, we developed and validated the first murine model of VSG that recapitulates the blood pressure-lowering effect of VSG using gold-standard radiotelemetry technology. We used this model to investigate several potential mechanisms, including body mass, brain endoplasmic reticulum (ER stress signaling and brain inflammatory signaling, which are all critical contributors to the pathogenesis of obesity-associated hypertension. Mice fed on a high-fat diet underwent sham or VSG surgery and radiotelemeter implantation. Sham mice were fed ad libitum or were food restricted to match their body mass to VSG-operated mice to determine the role of body mass in the ability of VSG to lower blood pressure. Blood pressure was then measured in freely moving unstressed mice by radiotelemetry. VSG decreased energy intake, body mass and fat mass. Mean arterial blood pressure (MAP was reduced in VSG-operated mice compared with both sham-operated groups. VSG-induced reductions in MAP were accompanied by a body mass-independent decrease in hypothalamic ER stress, hypothalamic inflammation and sympathetic nervous system tone. Assessment of gut microbial populations revealed VSG-induced increases in the relative abundance of Gammaproteobacteria and Enterococcus, and decreases in Adlercreutzia. These results suggest that VSG reduces blood pressure, but this is only partly due to the reduction in body weight. VSG-induced reductions in blood pressure may be driven by a decrease in hypothalamic ER stress and inflammatory signaling, and shifts in gut microbial populations.

  8. The effect of vertical sleeve gastrectomy on food choice in rats.

    Science.gov (United States)

    Wilson-Pérez, H E; Chambers, A P; Sandoval, D A; Stefater, M A; Woods, S C; Benoit, S C; Seeley, R J

    2013-02-01

    Diets high in fat are implicated in the development and maintenance of obesity, and obese individuals display greater preferences for high-fat foods than do their lean counterparts. Weight-reduction bariatric surgery is associated with changes in food choice. In particular, after Roux-en-Y gastric bypass (RYGB), humans and rodents select or prefer foods that are lower in fat content. We asked whether a bariatric surgical procedure limited to the stomach, vertical sleeve gastrectomy (VSG), causes a similar reduction of fat intake/preference. Rats received VSG or Sham surgery or remained surgically naïve, and were assessed for food preference using three diet-choice paradigms. Using progressive-ratio (PR) and conditioned taste aversion paradigms, we further asked whether surgically induced changes in food choice are secondary to changes in the reward value of food and/or to the formation of a food aversion. Finally, food choice was compared between VSG- and RYGB-operated rats. VSG rats decreased their intake of dietary fat, and shifted their preference toward lower caloric-density foods. This change in food choice was not associated with changes in motivated responding on a PR schedule for either a fat or a carbohydrate food reinforcer. When VSG and RYGB were compared directly, both procedures caused comparable changes in food choice. The conditioned taste aversion paradigm revealed that VSG rats form an aversion to an intra-gastric oil administration whereas RYGB rats do not. VSG and RYGB, two anatomically distinct bariatric procedures, produce similar changes in food choice.

  9. Carotid intima-media thickness and ınsulin resistance changes in patients who underwent sleeve gastrectomy: A prospective study.

    Science.gov (United States)

    Yorulmaz, G; Cilekar, M; Bilge, U; Akcan, E; Akalin, A

    2016-01-01

    Our aim was to examine changes in insulin resistance, Carotid Intima-Media Thickness (CIMT), in morbid obese patients without any known associated chronic diseases who underwent sleeve gastrectomy. The subjects of this study were patients with minimum BMI of 40, who did not have any known chronic diseases. Sleeve gastrectomy was performed and perioperative control endoscopy was performed. The following values were measured before the operation and after follow-up period after the operation: Fasting blood glucose and insulin, lipid profile, BMI, liver function tests, right and left CIMT. Furthermore, the patients' insulin resistance was calculated by HOMA method, and the values of 2.7. Six-teen patients (14 women and 2 men, average age: 39.12 ± 10.63 years), who did not have a known additional chronic disease, took part in the study. There was a significant difference between baseline and follow-up values of the patients, and the mean weight loss was 20.5%. Given the statistical evaluation of baseline and follow-up values, there was a significant difference in BMI, insulin resistance rates and right and left CIMT values. Bariatric surgery may provide some additional advantages for the management of cardiovascular risks in obese patients. However, it should be kept in mind that the most important components of fight against obesity are appropriate diet and exercise programs.

  10. Effect of Roux-en-Y gastric bypass and sleeve gastrectomy on taste acuity and sweetness acceptability in postsurgical subjects.

    Science.gov (United States)

    El Labban, Sibelle; Safadi, Bassem; Olabi, Ammar

    2016-01-01

    Data on taste acuity after bariatric surgery are scarce, and taste perception after sleeve gastrectomy, to our knowledge, has never been investigated. The objective of this work was to retrospectively compare taste acuity and sweetness acceptability after Roux-en-Y gastric bypass and sleeve gastrectomy. Subjects with a postoperative period ≥6 mo were recruited (between January and June 2012) for a non-randomized, observational study. Subjects completed sensory evaluation sessions consisting of measurement of detection thresholds for bitterness and sweetness (N = 21), saltiness and sourness (N = 19), and sweetness acceptability (N = 19). Significance was established with Tukey's honest significant difference test and analysis of variance using the SAS GLM procedure. Sourness threshold was significantly higher among subjects who had undergone Roux-en-Y gastric bypass (P = 0.0045). No other differences were obtained for the other thresholds or sweetness acceptability (P > 0.05). Further randomized studies are needed to clarify these differences. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Investigating Nutritional Deficiencies in a Group of Patients 3 Years Post Laparoscopic Sleeve Gastrectomy.

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    Zarshenas, Nazy; Nacher, Maria; Loi, Ken W; Jorgensen, John O

    2016-12-01

    Laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure has shown to be effective in achieving significant weight loss and resolving obesity-related co-morbidities. However, its nutrition consequences have not been extensively explored. This study aims to investigate weight loss and evolution of nutritional deficiencies in a group of patients 3 years post LSG. Retrospective data of a group of patients, 3 years following LSG as a stand-alone procedure was collected. Data included anthropometry, nutritional markers (hemoglobin, iron studies, folate, calcium, iPTH, vitamins D, and B 12 ), and compliancy with supplementations. Ninety-one patients (male/female; 28:63), aged 51.9 ± 11.4 years with a BMI of 42.8 ± 6.1 kg/m 2 were identified to be 3 years post LSG. Percentage of weight loss at 1 and 3 years post-operatively was 29.8 ± 7.0 and 25.9 ± 8.8 %, respectively. Pre-operatively, the abnormalities included low hemoglobin (4 %), ferritin (6 %), vitamin B 12 (1 %), vitamin D (46 %), and elevated iPTH (25 %). At 3 years post-operatively, the abnormal laboratory values included low hemoglobin (14 % females, P = 0.021), ferritin (24 %, P = 0.011), vitamin D (20 %, P = 0.018), and elevated iPTH (17 %, P = 0.010). Compliancy with multivitamin supplementation was noted in 66 % of patients. In these patients, LSG resulted in pronounced weight loss at 1 year post-operatively, and most of this was maintained at 3 years. Nutritional deficiencies are prevalent among patients prior to bariatric surgery. These deficiencies may persist or exacerbate post-operatively. Routine nutrition monitoring and supplementations are essential to prevent and treat these deficiencies.

  12. Metabolic syndrome remission after Roux-en-Y gastric bypass or sleeve gastrectomy

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    Nassour I

    2017-09-01

    Full Text Available Ibrahim Nassour,1 Jaime P Almandoz,2 Beverley Adams-Huet,3,4 Sachin Kukreja,5 Nancy Puzziferri1,5 1Department of Surgery, 2Department of Internal Medicine, Division of Endocrinology, 3Department of Clinical Sciences, 4Department of Internal Medicine, University of Texas Southwestern Medical Center, 5Department of Surgery, Veterans Affairs North Texas Health Care System, Dallas, TX, USA Background: Bariatric surgery is known to decrease weight and the prevalence of comorbidities, but there is little evidence on the differential effect of Roux-en-Y gastric bypass (RYGB and sleeve gastrectomy (SG on the remission of the aggregate outcome, metabolic syndrome, 4 years after surgery. The purpose of this study was to determine the effectiveness of RYGB and SG on metabolic syndrome in veterans. Methods: We retrospectively reviewed consecutive patients who underwent SG and RYGB at the Dallas Veterans Affairs Medical Center from 2003 to 2012. We determined the effect of both the operations on the remission of metabolic syndrome, its individual components, and medium-term morbidity and mortality. A sensitivity analysis was performed using propensity matching.Results: A total of 266 patients were identified (159 RYGB and 107 SG with 96% follow-up after 4 years. The mean age of the cohort was 51.4 years; the majority of patients were male (59% and Caucasian (69%. RYGB patients had a greater mean body mass index and were more likely to have hypertension or hypertriglyceridemia. RYGB was associated with a similar metabolic syndrome remission to SG (37.6% vs 26.8%; P=0.09. The percentage of weight loss was 26.5% after RYGB and 10.8% after SG at 4 years post operation (P<0.01. Predictors of metabolic syndrome persistence were male gender, type 2 diabetes, and low high-density lipoprotein. While both the operations were associated with similar mortality (RYGB 4.4%, SG 2.8%; P=0.74, RYGB was associated with a greater rate of morbidity. Conclusion: RYGB and SG seem

  13. Sleeve Gastrectomy: Correlation of Long-Term Results with Remnant Morphology and Eating Disorders.

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    Tassinari, Daniele; Berta, Rossana D; Nannipieri, Monica; Giusti, Patrizia; Di Paolo, Luca; Guarino, Daniela; Anselmino, Marco

    2017-11-01

    Remnant dimension is considered one of the crucial elements determining the success of sleeve gastrectomy (SG), and dilation of the gastric fundus is often believed to be the main cause of failure. The main outcome of this study is to find correlations between remnant morphology in the immediate post-operative stage, its dilation in years, and the long-term results. The second purpose aims to correlate preoperative eating disorders, taste alteration, hunger perception, and early satiety with post-SG results. Remnant morphology was evaluated, in the immediate post-operative stage and over the years (≥2 years), through X-ray of the oesophagus-stomach-duodenum calculating the surface in anteroposterior (AP) and right anterior oblique projection (RAO). Presurgery diagnosis of eating disorders and their evaluation through "Eating Disorder Inventory-3" (EDI3) during follow-up were performed. Change in taste perception, sense of appetite, and early satiety were evaluated. Patients were divided into two groups: "failed SGs (EWL50%). There were a total of 50 patients (37 F, 13 M), with mean age 52 years, preoperative weight 131 ± 21.8 kg, and BMI 47.4 ± 6.8 kg/m 2 . Post-operative remnant mean dimensions overlapped between the two groups. On a long-term basis, an increase of 57.2 and 48.4% was documented in the AP and RAO areas respectively. In "failed" SGs, dilation was significantly superior to "efficient" SGs (AP area 70.2 vs 46.1%; RAO area 59.3 vs 39%; body width 102% vs 41.7%). Preoperative eating disorders were more present in efficient SGs than in failed SGs with the exception of sweet eating. There were no significant changes to taste perception during follow-up. Fifty-two percent of efficient SGs vs 26% of failed SGs reported a persistent lack of sense of hunger; similarly, 92.5 vs 78% declared the persistence of a sense of early satiety. The two groups did not statistically differ as far as all the variables of the EDI3 are concerned. On a long

  14. Evaluation of Nutritional Status Post Laparoscopic Sleeve Gastrectomy-5-Year Outcomes.

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    Al-Mutawa, Aliaa; Al-Sabah, Salman; Anderson, Alfred Kojo; Al-Mutawa, Mohammad

    2017-12-01

    Obesity is considered a public health problem and has led to advancements in bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) had become the most performed procedure worldwide; however, its consequences on nutritional status in the short and long term are of concern. A retrospective analysis of medical records and bariatric database of patients who underwent LSG from October 2008-September 2015 at Al-Amiri Hospital, Kuwait, was performed. Data regarding nutritional status along with demographic data were collected over a 5-year follow-up period. One thousand seven hundred ninety-three patients comprising of 74% females and 26% males were included. The greatest % total body weight loss (%TBWL) was at 18 months post-LSG (33%), corresponding to a % excess weight loss (%EWL) of 73.8%. With regard to nutritional status, vitamin B1 showed a significant drop at 3-5 years post-op in comparison to pre-op value, but stayed within the normal range throughout the study. Red blood cells count, hemoglobin, and hematocrit also showed a significant drop starting from 6 months post-op until the fifth year of follow-up. On the other hand, vitamins B6 and B12 showed a significant increase at 6 months post-op and decreased afterwards, but did not reach pre-op values. Vitamin D also showed a significant increase throughout the study period from deficient value at the pre-op time, but remained insufficient. Albumin, transferrin, folate, ferritin, iron, and vitamin B2 showed no significant changes at 5 years post-LSG compared to pre-op values. Little is known about the nutritional status and optimal nutritional care plan post-LSG, especially in the longer term. Nutritional deficiencies were prevalent prior and post-LSG. Some of the nutritional parameters improved and even reached the abnormal high level post-LSG. These observations highlight the importance of pre- and post-operative nutritional assessment and tailored supplementation to ensure optimal nutritional status.

  15. Medium-Term Results of Laparoscopic Sleeve Gastrectomy: a Matched Comparison with Gastric Bypass.

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    Lee, Wei-Jei; Pok, Eng-Hong; Almulaifi, Abdullah; Tsou, Ju Juin; Ser, Kong-Han; Lee, Yi-Chih

    2015-08-01

    Laparoscopic sleeve gastrectomy (LSG) is considered a primary bariatric surgery and is increasingly being performed worldwide; however, long-term data regarding the durability of this procedure are inadequate. Here, we report the long-term results of LSGs in comparison to those of gastric bypass surgeries. A prospectively collected bariatric database from Ming-Shen General Hospital was retrospectively studied. Five hundred nineteen morbidly obese patients (mean age 36.0 ± 9.1 years old (14-71), 74.6 % female, mean body mass index (BMI) 37.5 ± 6.1 kg/m(2)) underwent LSG as a primary bariatric procedure from 2006 to 2012 at our institute. The operative parameters, weight loss, laboratory data, and quality of life were followed. Another two matched groups of laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic single anastomosis (mini-) gastric bypass (SAGB) patients who were matched in terms of age, sex, and BMI were recruited for comparisons. The mean surgical time for LSG was 113.5 ± 31.3 min, and the mean blood loss was 49.1 + 100.9 ml. The rate of major complications was 1.6 %, and the average length of the postoperative stay was 3.0 ± 1.7 days. The operation times of the RYGB patients were longer than those of both the LSG and SAGB patients. The RYGB and SAGB patients experienced higher major complication rate than the LSG patients. The weight loss of the LSG patient at 5 years was 28.3 + 8.9 %, and the mean BMI was 27.1 + 4.3. The RYGB patients exhibited a 5-year weight loss similar to the LSG patients, and the SAGB patients exhibited greater weight loss than both of the other groups. Both the RYGB and SAGB patients exhibited significantly better glycemic control and lower blood lipids than the LSG patients, but the LSG patients exhibited a lesser micronutrient deficiency than the RYGB and SAGB groups. All three of the groups exhibited improved quality of life at 5 years after surgery, and there was no significant

  16. Patterns of Abnormal Gastric Pacemaking After Sleeve Gastrectomy Defined by Laparoscopic High-Resolution Electrical Mapping.

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    Berry, Rachel; Cheng, Leo K; Du, Peng; Paskaranandavadivel, Niranchan; Angeli, Timothy R; Mayne, Terence; Beban, Grant; O'Grady, Gregory

    2017-08-01

    Laparoscopic sleeve gastrectomy (LSG) is increasingly being applied to treat obesity. LSG includes excision of the normal gastric pacemaker, which could induce electrical dysrhythmias impacting on post-operative symptoms and recovery, but these implications have not been adequately investigated. This study aimed to define the effects of LSG on gastric slow-wave pacemaking using laparoscopic high-resolution (HR) electrical mapping. Laparoscopic HR mapping was performed before and after LSG using flexible printed circuit arrays (64-96 electrodes; 8-12 cm 2 ; n = 8 patients) deployed through a 12 mm trocar and positioned on the gastric serosa. An additional patient with chronic reflux, nausea, and dysmotility 6 months after LSG also underwent gastric mapping while undergoing conversion to gastric bypass. Slow-wave activity was quantified by propagation pattern, frequency, velocity, and amplitude. Baseline activity showed exclusively normal propagation. Acutely after LSG, all patients developed either a distal unifocal ectopic pacemaker with retrograde propagation (50%) or bioelectrical quiescence (50%). Propagation velocity was abnormally rapid after LSG (12.5 ± 0.8 vs baseline 3.8 ± 0.8 mm s -1 ; p = 0.01), whereas frequency and amplitude were unchanged (2.7 ± 0.3 vs 2.8 ± 0.3 cpm, p = 0.7; 1.7 ± 0.2 vs 1.6 ± 0.6 mV, p = 0.7). In the patient with chronic dysmotility after LSG, mapping also revealed a stable antral ectopic pacemaker with retrograde rapid propagation (12.6 ± 4.8 mm s -1 ). Resection of the gastric pacemaker during LSG acutely resulted in aberrant distal ectopic pacemaking or bioelectrical quiescence. Ectopic pacemaking can persist long after LSG, inducing chronic dysmotility. The clinical and therapeutic significance of these findings now require further investigation.

  17. Laparoscopic omega-loop gastric bypass for the conversion of failed sleeve gastrectomy: early experience.

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    Moszkowicz, D; Rau, C; Guenzi, M; Zinzindohoué, F; Berger, A; Chevallier, J-M

    2013-12-01

    Despite the initial effectiveness of sleeve gastrectomy (SG), some patients who undergo this purely restrictive technique have inadequate weight loss or renewed weight gain and persistent obesity-related co-morbidities with their potentially lethal complications. In such patients, the conversion of SG by the addition of a malabsorptive technique may then be necessary. Conversion of SG to a mini gastric bypass (MGBP) was evaluated for failure of weight loss. An ante-colic end-to-side stapled gastro-jejunal anastomosis was performed laparoscopically, connecting the long narrow gastric tube to the jejunum at a point 200cm downstream from the ligament of Treitz. Between October 2006 and February 2012, 651 laparoscopic MGBP were performed for morbid obesity. Twenty-three of these patients (3.5%) had previously undergone SG. The conversion from SG to MGPB was performed laparoscopically in 19 of the 23 patients (81%) at a mean interval of 26.3months (8.2-63.7). The 30-day postoperative mortality rate was zero and the morbidity rate was 9.5%. The mean BMI before MGBP was 44±7.7kg (35.8-55.4). Conversion of SG to MGBP resulted in additional weight loss, achieving a mean BMI of 39.9 with a 26.8% loss of excess BMI (EBL) at 3months, mean BMI of 36.5 with 37.2% EBL at 12months, mean BMI of 36.2 with 48.6% EBL at 18months, and mean BMI of 35.7 with EBL of 51.6% at 24months. The overall mean EBL was 57.3±19.5% (range: 25-82%) at 42.3months (range 16.7-60.8months). Conversion of SG to MGBP is feasible, safe and effective, and results in significant additional weight loss. Definitive results at 2 and 5years are awaited for the long-term procedure validation. Copyright © 2013. Published by Elsevier Masson SAS.

  18. Ileal interposition with sleeve gastrectomy for treatment of type 2 diabetes mellitus

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    Sunil Kumar Kota

    2012-01-01

    Full Text Available Aim: Combination of laparoscopic ileal interposition (II with sleeve gastrectomy (SG is an upcoming procedure, which offers good metabolic improvement and weight reduction without causing significant malabsorption. The objective of this study was to evaluate the results of this novel procedure for control of type 2 diabetes, obesity, hypertension, and related metabolic abnormalities. Materials and Methods: The II and SG was performed in 43 patients (M:F = 25:18 from February 2008. Participants had a mean age of 47.2 ± 8.2 years (range 29-66 years, mean duration of diabetes of 10.1 ± 9.2 years (range 1-32 years, and mean preoperative body mass index (BMI of 33.2 ± 7.8 kg/m2. All patients had poorly controlled type 2 diabetes mellitus (DM [mean glycated hemoglobin (HbA1C 9.6 ± 2.1%] despite use of oral hypoglycemic agents (OHAs and/or insulin. Thirty (70% patients had hypertension, 20 (46% had dyslipidemia, and 18 (42% had significant microalbuminuria. The primary outcome was remission of diabetes (HbA1C < 6.5% without OHAs/insulin and the secondary outcomes were reduction in antidiabetic agent requirement and components of metabolic syndrome. Results: Mean follow-up was for 20.2 ± 8.6 months (range 4-40 months. Postoperatively, glycemic parameters (fasting and post-lunch blood sugar, HbA1C improved in all patients (P < 0.05 at all intervals. Twenty (47% patients had remission in diabetes and the remaining patients showed significantly decreased OHA requirement. All patients had weight loss between 15 and 30% (P < 0.05. Twenty-seven (90% patients had remission in hypertension. At 3 years, the mean fall in HbA1C (34% was more than reduction in BMI (25%. There was a declining trend in lipids and microalbuminuria postoperatively, though it was significant for microalbuminuria only. Conclusions: The laparoscopic II with SG seems to be a promising procedure for control of type 2 DM, hypertension, weight reduction, and associated metabolic

  19. Optical Coherence Tomography Parameters in Morbidly Obese Patients Who Underwent Laparoscopic Sleeve Gastrectomy

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    Berna Dogan

    2016-01-01

    Full Text Available Purpose. To investigate changes in optical coherence tomography parameters in morbidly obese patients who had undergone laparoscopic sleeve gastrectomy (LSG. Methods. A total of 41 eyes of 41 morbidly obese patients (BMI ≥ 40 who had undergone LSG were included in study. The topographic optic disc parameters, central macular thickness (CMT, total macular volume (TMV, and retinal ganglion cell layer (RGCL were measured by spectral-domain optical coherence tomography (SD-OCT. Subfoveal choroidal thickness (SFCT was measured by enhanced deep imaging-optical coherence tomography (EDI-OCT. Results. The mean CMT was 237.4±24.5 μm, 239.3±24.1 μm, and 240.4±24.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean TMV was 9.88±0.52 mm3, 9.96±0.56 mm3, and 9.99±0.56 mm3 preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean RGCL was 81.2±6.5 μm, 82.7±6.6 μm, and 82.9±6.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean SFCT was 309.8±71.8 μm, 331.0±81.4 μm, and 352.7±81.4 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. No statistically significant differences were found between the preoperative values and 3- and 6-month postoperative values in rim area (p=0.34, disc area (p=0.64, vertical cup/disc ratio (p=0.39, cup volume (p=0.08, or retinal nerve fiber layer (p=0.90. Conclusions. Morbidly obese patients who undergo LSG experience a statistically significant increase in CMT, TMV, SFCT, and RGCL at 3 months and 6 months after surgery.

  20. Achalasia: A case report on its effect during surgical decision making for laparoscopic sleeve gastrectomy in the young morbidly obese patient

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    Rodolfo J. Oviedo, MD, FACS

    2016-01-01

    Conclusion: The patient has already undergone a POEM procedure, which was chosen to maintain the gastric fundus, cardia, and gastroesophageal junction (GEJ architecture as opposed to a LHM with Dor fundoplication, which would have altered the anatomy, thus making a concomitant laparoscopic sleeve gastrectomy an unfeasible option.

  1. Laparoscopic sleeve gastrectomy without over-sewing the staple line: A case series demonstrating efficacy and minimization of both intra- and post-operative complications

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    Dr. S. Moradian, DO

    2017-01-01

    Conclusion: Our technique, to our knowledge, is the first to describe laparoscopic sleeve gastrectomy without over-sewing the staple line, no post-operative anticoagulation, no UGI series on POD#1, and discharge home on POD#1 with no major complications.

  2. Prevalence of Chronic Gastritis or Helicobacter pylori Infection in Adolescent Sleeve Gastrectomy Patients Does Not Correlate with Symptoms or Surgical Outcomes.

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    Franklin, Ashanti L; Koeck, Emily S; Hamrick, Miller C; Qureshi, Faisal G; Nadler, Evan P

    2015-08-01

    In adults undergoing gastric bypass surgery, it is routine practice to perform pre-operative testing for Helicobacter pylori infection. Evidence suggests that infection impairs anastomotic healing and contributes to complications. There currently are no data for adolescents undergoing bariatric procedures. Despite few patients with pre-operative symptoms, we noted occasional patients with H. pylori detected after sleeve gastrectomy. We reviewed our experience with our adolescent sleeve gastrectomy cohort to determine the prevalence of H. pylori infection, its predictive factors, and association with outcomes. We hypothesized that H. pylori infection would be associated with pre-operative symptoms, but not surgical outcomes. All patients undergoing sleeve gastrectomy at our hospital were included. We conducted a chart review to determine pre- or post-operative symptoms of gastroesophageal reflux disease GERD or gastritis, operative complications, and long-term anti-reflux therapy after surgery. Pathology reports were reviewed for evidence of gastritis and H. pylori infection. 78 adolescents had laparoscopic sleeve gastrectomy from January 2010 through July 2014. The prevalence of chronic gastritis was 44.9% (35/78) and 11.4% of those patients had H. pylori (4/35). Only one patient with H. pylori had pre-operative symptoms, and only 25.7% (9/35) of patients with pathology-proven gastritis had symptoms. One staple line leak occurred but this patient did not have H. pylori or gastritis. Mean patient follow-up was 10 (3-26) mos. There is a moderate prevalence of gastritis among adolescents undergoing sleeve gastrectomy, but only a small number of these patients had H. pylori infection. Neither the presence of chronic gastritis nor H. pylori infection correlated with symptoms or outcomes. Thus, in the absence of predictive symptomology or adverse outcome in those who are infected, we advocate for continued routine pathologic evaluation without the required need for pre

  3. Time-resolved MRI after ingestion of liquids reveals motility changes after laparoscopic sleeve gastrectomy--preliminary results.

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    Baumann, Tobias; Kuesters, Simon; Grueneberger, Jodok; Marjanovic, Goran; Zimmermann, Lisa; Schaefer, Arnd-Oliver; Hopt, Ulrich Theodor; Langer, Mathias; Karcz, Wojciech Konrad

    2011-01-01

    Laparoscopic sleeve gastrectomy (LSG) is generally considered a restrictive procedure. However, studies with nuclear medicine techniques have demonstrated that gastric motility changes occur following LSG. These motility changes could represent complementary mechanisms of weight loss. Therefore, we analyzed the stomach motility before and after LSG by means of dynamic MRI. In this prospective pilot study, five female patients with a mean BMI of 51.6 kg/m(2) underwent MRI 1 day before LSG and 6 days and 6 months after LSG. Dynamic steady-state free precession sequences were used to analyze the gastric motility after ingestion of 500 ml water with a temporal resolution of 0.86 s. Axial image stacks were also repeatedly acquired to determine the intragastric fluid volume over time. Mean excess body mass index loss was 60.6% after 6 months. Dynamic analysis showed that antral propulsive peristalsis was preserved immediately after surgery and during follow-up, but fold speed increased significantly from 2.7 mm/s before LSG to 4.4 mm/s after 6 months. The sleeve itself remained without recognizable peristalsis in three patients and showed only uncoordinated or passive motion in two patients. Consequently, the fluid transport through the sleeve was markedly delayed, whereas the antrum showed accelerated propulsion with the emptying half-time decreasing from 16.5 min preoperatively to 7.9 min 6 months after surgery. Owing to the LSG procedure, the stomach is functionally divided into a sleeve without propulsive peristalsis and an accelerated antrum. Accelerated emptying seems to be caused by faster peristaltic folds.

  4. Repeat sleeve gastrectomy: optimization of outcomes by modifying the indications and technique.

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    Rebibo, Lionel; Dhahri, Abdennaceur; Robert, Brice; Regimbeau, Jean-Marc

    2018-04-01

    Few series are available concerning repeat sleeve gastrectomy (re-SG), and series have reported contradictory results concerning morbidity rates, with limited data concerning weight loss. Evaluate the short- and medium-term outcomes of re-SG. University hospital, France, public practice. Between June 2007 and March 2016, all patients undergoing re-SG (n = 46 patients) were included. Re-SG was proposed for patients with insufficient excess weight loss (EWL) (≤50%) or renewed weight gain with excessively high residual gastric volume (>250 mL and/or large gastric pouch). The primary efficacy endpoint was the overall complication rate of re-SG. The secondary efficacy endpoints were operative data, evaluation of weight loss, and correction of co-morbidities, risk factors for gastric leak (GL), by comparing 2 periods (period 1, January 2004-December 2013: blue/green or purple staplers without reinforcement; period 2, after December 2013: black staplers with reinforcement) and comparison of weight loss according to the indication for re-SG. The re-SG group consisted of 46 patients (35 women, mean age: 47.5 yr). The mean body mass index (BMI) before SG was 47.2 kg/m² (35-63.6). The mean time interval between SG and re-SG was 73 months (11-106). The BMI before re-SG was 41.2 kg/m² (29-54.7). Indications for surgery were insufficient weight loss in 25 patients (54.3%) and weight regain in 21 patients (45.7%). A large gastric pouch was visible in 4 patients (8.6%). The mean operating time was 97.6 minutes (45-220). One death (2.1%) and 7 complications (15.2%) were observed. The mean length of hospital stay was 3.6 days (1-30). At last follow-up, mean BMI was 32.1 kg/m 2 (20.3-41.3) and mean EWL was 62.3% (18-127.2). When analyzing risk factors for GL, residual gastric volume between 250 and 350 mL was associated with a higher GL rate compared with a volume ≥350 mL, and re-SG performed during period 1 was associated with a higher GL rate than re-SG performed during

  5. Surgical models of Roux-en-Y gastric bypass surgery and sleeve gastrectomy in rats and mice.

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    Bruinsma, Bote G; Uygun, Korkut; Yarmush, Martin L; Saeidi, Nima

    2015-03-01

    Bariatric surgery is the only definitive solution currently available for the present obesity pandemic. These operations typically involve reconfiguration of gastrointestinal tract anatomy and impose profound metabolic and physiological benefits, such as substantially reducing body weight and ameliorating type II diabetes. Therefore, animal models of these surgeries offer unique and exciting opportunities to delineate the underlying mechanisms that contribute to the resolution of obesity and diabetes. Here we describe a standardized procedure for mouse and rat models of Roux-en-Y gastric bypass (80-90 min operative time) and sleeve gastrectomy (30-45 min operative time), which, to a high degree, resembles operations in humans. We also provide detailed protocols for both pre- and postoperative techniques that ensure a high success rate in the operations. These protocols provide the opportunity to mechanistically investigate the systemic effects of the surgical interventions, such as regulation of body weight, glucose homeostasis and gut microbiome.

  6. Early morbidity and mortality of laparoscopic sleeve gastrectomy and gastric bypass in the elderly: a NSQIP analysis.

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    Spaniolas, Konstantinos; Trus, Thadeus L; Adrales, Gina L; Quigley, Maureen T; Pories, Walter J; Laycock, William S

    2014-01-01

    Even though the U.S. population is aging, outcomes of bariatric surgery in the elderly are not well defined. Current literature mostly evaluates the effects of gastric bypass (RYGB), with paucity of data on sleeve gastrectomy (SG). The objective of this study was to assess 30-day morbidity and mortality associated with laparoscopic SG in patients aged 65 years and over, in comparison to RYGB. The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients aged 65 and over who underwent laparoscopic RYGB and SG between 2010 and 2011. Baseline characteristics and outcomes were compared. P valuelaparoscopic bariatric surgery, SG is not associated with significantly different 30-day outcomes compared to RYGB. Both procedures are followed by acceptably low morbidity and mortality. Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  7. Laparoscopic sleeve gastrectomy with duodeno-jejunal bypass for morbid obesity in a patient with situs inversus totalis.

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    Watanabe, Atsushi; Seki, Yosuke; Kasama, Kazunori

    2016-08-01

    Laparoscopic sleeve gastrectomy with duodeno-jejunal bypass (LSG/DJB) has been adopted in our center for the treatment of morbidly obese patients with both severe type 2 diabetes mellitus and existing risks factors for gastric cancer. We have successfully performed over 200 LSG/DJB procedures in our institution. Here we report the techniques used to perform LSG/DJB in a morbidly obese patient with situs inversus totalis. The only significant difference in executing LSG/DJB between normal anatomy and situs inversus totalis is changing the surgeon's position and switching the trocar placements during the intraoperative phase. Consequently, there were no significant difference in operative time between normal anatomy cases and the situs inversus totalis case. © 2016 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  8. Roux-en-Y Gastric Bypass Surgery But Not Vertical Sleeve Gastrectomy Decreases Bone Mass in Male Rats

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    Stemmer, Kerstin; Bielohuby, Maximilian; Grayson, Bernadette E.; Begg, Denovan P.; Chambers, Adam P.; Neff, Christina; Woods, Stephen C.; Erben, Reinhold G.; Tschöp, Matthias H.; Bidlingmaier, Martin; Clemens, Thomas L.

    2013-01-01

    The most effective treatment for obesity is bariatric surgery. However, there is increasing concern that bariatric surgery can cause nutrient deficiencies that translate into metabolic bone disease. Whether this is true for all surgery types is not yet clear. We therefore investigated the effects of 2 commonly applied bariatric surgeries (Roux-en-Y gastric bypass [RYGB] and vertical sleeve gastrectomy) on energy and bone metabolism in rats 60 days after surgery. Both surgeries resulted in similar reductions of body weight, body fat, and food intake. Glucose tolerance was improved to a similar extent after both surgeries and was accompanied by increased postprandial secretion of glucose-dependent insulinotropic peptide. Using microcomputed tomography, we found that, relative to sham-operated rats, bone volume was significantly reduced after RYGB but not vertical sleeve gastrectomy. RYGB rats also had markedly reduced lipid absorption from the intestine and significantly lower serum 25-hydroxyvitamin D and calcium levels. Importantly, dietary supplementation with calcium and vitamin D could not fully rescue the reduced bone volume after RYGB surgery. Both surgeries resulted in a significant increase in stomach pH, which may have worsened the malabsorption in RYGB rats. Our findings suggest that bone loss in RYGB rats is not exclusively driven by calcium and vitamin D malabsorption but also by additional factors that may not be rescuable by dietary supplementation. These data point toward important similarities and differences between bariatric procedures that should be considered in clinical settings as guidance for which procedure will be best for specific patient populations. PMID:23554454

  9. Change in levels of C-reactive protein (CRP) and serum cortisol in morbidly obese patients after laparoscopic sleeve gastrectomy.

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    Ruiz-Tovar, Jaime; Oller, Inmaculada; Galindo, Isabel; Llavero, Carolina; Arroyo, Antonio; Calero, Alicia; Diez, María; Zubiaga, Lorea; Calpena, Rafael

    2013-06-01

    C-Reactive protein (CRP) has been associated with the macro- and microvascular effects of hypertension and diabetes mellitus. Referring to serum cortisol, it has been proposed to contribute to the pathogenesis of metabolic syndrome, and it has been demonstrated that weight loss normalizes cortisol levels and improves insulin resistance. The aims of this study were to analyze CRP and cortisol levels pre- and postoperatively in morbidly obese patients undergoing a laparoscopic sleeve gastrectomy and to correlate them with weight loss and parameters associated with cardiovascular risk. A prospective study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between October 2007 and May 2011 was performed. A total of 40 patients were included in the study. CRP levels decreased significantly 12 months after surgery (median reduction of 8.9 mg/l; p = 0.001). Serum cortisol levels decreased significantly 6 months after surgery (median reduction of 34.9 μg/dl; p = 0.001). CRP values reached the normal range (cortisol, a significant association was observed with the cardiovascular risk predictor (triglyceride/high-density lipoprotein cholesterol ratio) from the 6th month after surgery onward (Pearson correlation coefficient, 0.559; p = 0.008). CRP levels are increased preoperatively and in the postoperative course up to 1 year after surgery. Serum cortisol levels remain elevated until the 6th month after surgery. From this moment onward, serum cortisol is associated with the cardiovascular risk predictor reflecting the cardiovascular risk decreasement during the weight loss.

  10. Pre-operative and early post-operative factors associated with surgical site infection after laparoscopic sleeve gastrectomy.

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    Ruiz-Tovar, Jaime; Oller, Inmaculada; Llavero, Carolina; Arroyo, Antonio; Muñoz, Jose Luis; Calero, Alicia; Diez, María; Zubiaga, Lorea; Calpena, Rafael

    2013-08-01

    Surgical procedures on obese patients are expected to have a high incidence of surgical site infection (SSI). The identification of pre-operative or early post-operative risk factors for SSI may help the surgeon to identify subjects in risk and adequately optimize their status. We conducted a study of the association of comorbidities and pre- and post-operative analytical variables with SSI following laparoscopic sleeve gastrectomy for the treatment of morbid obesity. We performed a prospective study of all morbidly obese patients undergoing laparoscopic sleeve gastrectomy as a bariatric procedure between 2007 and 2011. An association of clinical and analytical variables with SSI was investigated. The study included 40 patients with a mean pre-operative body mass index (BMI) of 51.2±7.9 kg/m(2). Surgical site infections appeared in three patients (7.5%), of whom two had an intra-abdominal abscess located in the left hypochondrium and the third had a superficial incisional SSI. Pre-operatively, a BMI >45 kg/m(2) (OR 8.7; p=0.008), restrictive disorders identified by pulmonary function tests (OR 10.0; p=0.012), a serum total protein concentration 30 mcg/dL (OR 13.0; p=0.003), and a mean corpuscular volume (MCV) operative SSI. Post-operatively, a serum glucose >128 mg/dL (OR 4.7; p=0.012) and hemoglobin operative anemia and hyperglycemia as risk factors for SSI. In these situations, the surgeon must be aware of and seek to control these risk factors.

  11. Comparison of short-term outcome of laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: A prospective randomized controlled multicenter SLEEVEPASS study with 6-month follow-up.

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    Helmiö, M; Victorzon, M; Ovaska, J; Leivonen, M; Juuti, A; Peromaa-Haavisto, P; Nuutila, P; Vahlberg, T; Salminen, P

    2014-09-01

    The long-term efficacy of laparoscopic Roux-en-Y gastric bypass in the treatment of morbid obesity has already been demonstrated. Laparoscopic sleeve gastrectomy has shown promising short-term results, but the long-term efficacy is still unclear. The aim of this prospective randomized multicenter study is to compare the results of Roux-en-Y gastric bypass and sleeve gastrectomy. A total of 240 morbidly obese patients were randomized to undergo either Roux-en-Y gastric bypass or sleeve gastrectomy. The primary end point of study was weight loss, and the secondary end points were resolution of comorbidities and morbidity. The short-term results at 6 months were analyzed. The mean excess weight loss at 6 months was 49.2% in the sleeve gastrectomy group and 52.9% in the Roux-en-Y gastric bypass group (p = 0.086). Type 2 diabetes was resolved or improved in 84.3% of patients in the sleeve gastrectomy group and 93.3% in the Roux-en-Y gastric bypass group (p = 0.585). The corresponding results for arterial hypertension were 76.8% and 81.9% (p = 0.707) and for hypercholesterolemia 64.1% and 69.0% (p = 0.485). There was no mortality at 6 months. There was one major complication following sleeve gastrectomy and two after Roux-en-Y gastric bypass (p = 0.531). Eight sleeve gastrectomy patients and 11 Roux-en-Y gastric bypass patients had minor complications (p = 0.403). The short-term results of sleeve gastrectomy and Roux-en-Y gastric bypass regarding weight loss, resolution of obesity-related comorbidities and complications were not different at 6 months. © The Finnish Surgical Society 2014.

  12. Successful Management of New-Onset Diabetes Mellitus and Obesity With the Use of Laparoscopic Sleeve Gastrectomy After Kidney Transplantation-A Case Report.

    Science.gov (United States)

    Chen, J H; Lee, C H; Chang, C M; Yin, W Y

    2016-04-01

    In kidney transplantation, obesity is associated with poorer graft survival and patient survival. Bariatric surgery may provide benefit for these patients, not only by inducing weight loss, but also via reduction of diabetes. We report a case of morbid obesity, poorly controlled new-onset diabetes mellitus, and gout after kidney transplantation that was treated with laparoscopic sleeve gastrectomy 3 years after kidney transplantation. After 1 year of follow-up, 76% excessive body weight loss was attained. No complications were noted. The operation also provided total remission of diabetes and gout as well as good graft survival. Based on our experience, laparoscopic sleeve gastrectomy may be a feasible treatment for obese patients after renal transplantation to help resolve obesity and control new-onset diabetes. However, the timing of operation and the long-term potential for graft and patient survivals with this operation require further study. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Prospective randomized clinical trial of laparoscopic sleeve gastrectomy versus open Roux-en-Y gastric bypass for the management of patients with morbid obesity

    OpenAIRE

    Paluszkiewicz, Rafa?; Kalinowski, Piotr; Wr?blewski, Tadeusz; Bartoszewicz, Zbigniew; Bia?obrzeska-Paluszkiewicz, Janina; Ziarkiewicz-Wr?blewska, Bogna; Remiszewski, Piotr; Grodzicki, Mariusz; Krawczyk, Marek

    2012-01-01

    Introduction Roux-en-Y gastric bypass (RYGB) is considered the gold standard bariatric procedure with documented safety and effectiveness. Laparoscopic sleeve gastrectomy (LSG) is a newer procedure being done with increasing frequency. Randomized comparisons of LSG and other bariatric procedures are limited. We present the results of the first prospective randomized trial comparing LSG and RYGB in the Polish population. Aim To assess the efficacy and safety of LSG versus RYGB in the treatment...

  14. Short- and Midterm Results between Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy for the Treatment of Morbid Obesity

    OpenAIRE

    Bandar Albeladi; Céline Bourbao-Tournois; Noel Huten

    2013-01-01

    Background. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures today, and laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular in Europe. The aim of this study was to compare short- and midterm results between LRYGB and LSG. Methods. An observational retrospective study from a database of patients undergoing LRYGB and LSG between January 2008 and June 2011. Seventy ...

  15. Perioperative morbi-mortality associated with bariatric surgery: from systematic biliopancreatic diversion to a tailored laparoscopic gastric bypass or sleeve gastrectomy approach.

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    de la Matta-Martín, Manuel; Acosta-Martínez, Jesús; Morales-Conde, Salvador; Herrera-González, Augusto

    2012-07-01

    The effectiveness and safety of the different bariatric surgical procedures currently available depend, partly, on the characteristics of the populations under study, the technical approach, the expertise of surgical teams, and on institutional factors. To evaluate the effectiveness and safety of these procedures, we compared the surgical results for biliopancreatic diversion surgery versus laparoscopic gastric bypass and sleeve gastrectomies performed in our institution. This was a retrospective observational study of 296 patients undergoing bariatric surgery from January 2005 through October 2010. We analyzed mortality rate, cardiocirculatory and pulmonary perioperative complications, duration of surgery, intensive care unit admissions, and length of stay. We describe the changes in the choice of the surgical procedures throughout the study period. We observed a rate of pulmonary complications of 2.3 % and a mortality rate 3 months after discharge of 2.36 % with sepsis secondary to anastomotic leak as the main cause of death. Biliopancreatic diversion surgery was associated with higher mortality rates (p value = 0.014) and longer hospital stay (median of 9 versus 6 days for laparoscopic gastric bypass and sleeve gastrectomy, p value laparoscopic restrictive and mixed techniques in our institution (from 0 % in 2005 to 87 % of all procedures in 2010). Bariatric surgery in our institution has dramatically shifted from systematic biliopancreatic diversion to a tailored laparoscopic gastric bypass or sleeve gastrectomy approach, which has made it possible to reduce hospital stay and mortality rates.

  16. Outcomes of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Patients Older than 60.

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    Abbas, Mujjahid; Cumella, Lindsay; Zhang, Yang; Choi, Jenny; Vemulapalli, Pratibha; Melvin, W Scott; Camacho, Diego

    2015-12-01

    The proportion of population older than 60 years is rapidly increasing. The majority of this older population suffers from multiple comorbid conditions including obesity. Non-surgical means of weight loss do not offer a predictable solution. Surgical interventions seem to be the most promising solution for the obesity problem, but there is a relative lack of data in literature regarding bariatric procedures in older populations. Our study aims to evaluate the safety and efficacy of bariatric surgery in patients older than 60 years of age, to determine the weight loss, rate of operation-related complications, and impacts of surgery on comorbid conditions, and to compare the effectiveness of bariatric surgery in older patients to the effectiveness of bariatric surgery for the general population at Montefiore Medical Center. A retrospective review of patients' medical records were used to collect data to create databases to identify patients older than 60 years age who underwent bariatric surgery procedures spanning a 4-year period between January 2009 and October 2013. Data reviewed included age, sex, height, pre-operative weight, and body mass index (BMI), presence of obesity-related comorbid conditions, procedures performed, mortality, immediate or delayed complications, length of follow-up, excess weight lost, BMI points lost, percent of excess weight loss (%EWL), hemoglobin Alc (HgbA1c), and effects on obesity-related comorbid conditions. The percent of excess weight loss and number of complications within the older patient group were compared to the general population, which consists of patients between the ages of 22 and 59. Ninety-eight patients were identified. Seven patients did not follow up at any time period, and the eight patients who had laparoscopic adjustable gastric band (LAGB) were also excluded due to insufficient data. Overall, 83 patients who were above the age of 60 were examined; 30 patients had laparoscopic sleeve gastrectomy (LSG), and 53

  17. Surgical management of super-super obese patients: Roux-en-Y gastric bypass versus sleeve gastrectomy.

    Science.gov (United States)

    Gonzalez-Heredia, Raquel; Sanchez-Johnsen, Lisa; Valbuena, Valeria S M; Masrur, Mario; Murphey, Melissa; Elli, Enrique

    2016-05-01

    Among morbidly obese adult patients (BMI >40 kg/m(2)), those who are super-super obese (BMI >60 kg/m(2)) present particular challenges for bariatric surgeons. Surgical management of super-super obese (SSO) patients has been associated with higher morbidity and mortality and increased surgical risk. The optimal surgical management of these patients is controversial. The aim of this study was to compare perioperative outcomes, percent excess weight loss (%EWL), and percent weight loss (%WL) in super-super obese patients who underwent either SG or RYGB. This study was a nonrandomized, controlled, retrospective review of 89 SSO patients who underwent SG or RYGB at the University of Illinois Hospital and Health Sciences System from January 2008 to June 2014. Patient demographics, pre-surgical comorbidities, perioperative parameters, post-operative complications (leak, conversion to open surgery, and 30-day mortality), and post-operative outcome months were examined. Seventy-seven patients underwent SG (nine robotic sleeve and 68 laparoscopic sleeve gastrectomy), and 12 underwent RYGB. The mean pre-operative BMI was 63.4 kg/m(2) (SD = 3.7 kg/m(2)). The mean operative time was 88.4 min (SD = 31.7) for the SG patients and 219.2 min (SD = 80.2) for the RYGB patients. There were no significant differences in complications or length of hospitalization between the groups. There were significant differences in %EWL and %WL at 12- and 24-month follow-up between groups (p's < 0.05). Based on the results from this sample of patients, SG and RYGB appear to be viable procedures for the surgical management of super-super obese patients. RYGB, however, provides a significantly higher %EWL and %WL at 12 and 24 months compared to SG, which in turn, yields acceptable but lower %EWL and %WL.

  18. Evaluation of insulin resistance improvement after laparoscopic sleeve gastrectomy or gastric bypass surgery with HOMA-IR.

    Science.gov (United States)

    Zhu, Yubing; Sun, Zhipeng; Du, Yanmin; Xu, Guangzhong; Gong, Ke; Zhu, Bin; Zhang, Nengwei

    2017-01-01

    Our purpose was to explore the remission of insulin resistance after bariatric surgery to discover the mechanism of diabetes remission excluding dietary factors. A retrospective case control study was conducted on patients with type 2 diabetes, who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic gastric bypass surgery (LGB) in Beijing Shijitan Hospital from April 1, 2012 to April 1, 2013. The laboratory and anthropometric data was analyzed pre-surgery and during a 2-year follow-up. HOMA-IR was calculated and evaluated. The two surgical procedures were compared. No significant difference in complete remission rate was observed between the two groups (LGB group: 62.1%, LSG group: 60.0%, p = 0.892). HOMA-IR was reduced to a stable level at the 3 rd month after surgery. The cut-off value of HOMA-IR was 2.38 (sensitivity: 0.938, specificity: 0.75) and 2.33 (sensitivity: 0.941, specificity: 0.778) respectively for complete remission after LSG or LGB surgery. Insulin resistance was improved while GLP-1 and Ghrelin was changed significantly in patients with type 2 diabetes prior to weight loss either in the LSG or LGB group. HOMA-IR decreased to less than the cut-off value at the 3 rd month and was closely related to complete remission. The mechanism of bariatric surgery was not due just to simply dietary factors or body weight loss but also the remission of insulin resistance.

  19. Determinants of Secondary Hyperparathyroidism in Bariatric Patients after Roux-en-Y Gastric Bypass or Sleeve Gastrectomy: A Pilot Study

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    Andreas Alexandrou

    2015-01-01

    Full Text Available Objective. Nutritional deficiencies are common after bariatric surgery. We aimed to assess the prevalence and possible predictors of secondary hyperparathyroidism (SHPT in bariatric patients. Methods. A total of 95 patients who had undergone Roux-en-Y gastric bypass (RYGB or sleeve gastrectomy (SG were assessed after a median of 3 years after surgery. Anthropometric/demographic and weight-loss parameters were compared according to the presence of SHPT, independently for men/premenopausal women and postmenopausal women. Results. SHPT was highly prevalent (men/premenopausal women, 52.1%; postmenopausal women, 31.9%. Among men/premenopausal women, multivariate analysis indicated that SHPT was predicted by (a 25-hydroxyvitamin D levels (Exp(B = 0.869, P-value = 0.037, independently of age, sex, smoking; (b calcium (Exp(B = 0.159, P-value = 0.033 and smoking, independently of age and sex; (c magnesium (Exp(B = 0.026, P-value = 0.046 and smoking, independently of age and sex. Among postmenopausal women, SHPT was predicted by menopausal age independently of age, smoking, and levels of 25-hydroxyvitamin D or calcium. The development of SHPT was not associated with the type of surgery. Conclusions. RYGB and SG exhibited similar effects regarding the regulation of the hypothalamus-pituitary-parathyroid axis after surgery. Vitamin D status and menopausal age appear to determine SHPT on the long term. SHPT should be sought and vigorously treated with calcium and vitamin D supplementation.

  20. The Effects of Sleeve Gastrectomy on Glucose Metabolism and Glucagon-Like Peptide 1 in Goto-Kakizaki Rats

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    Laiyuan Li

    2018-01-01

    Full Text Available Purpose. To investigate the effects of sleeve gastrectomy (SG on glucose metabolism and changes in glucagon-like peptide 1 (GLP-1 in Goto-Kakizaki (GK rats. Methods. GK rats were randomly assigned to one of three groups: SG, SG pair-fed plus sham surgery (PF-sham, and ad libitum-fed no surgery (control. Food intake, body weight, blood glucose, GLP-1 and insulin levels, and GLP-1 expression in the jejunum and ileum were compared. Results. The SG rats exhibited lower postoperative food intake, body weight, and fasting glucose than did the control rats (P<0.05. SG significantly improved glucose and insulin tolerance (P<0.05. Plasma GLP-1 levels were higher in SG rats than in control or PF-sham rats in the oral glucose tolerance test (OGTT (P<0.05. Blood glucose levels expressed as a percentage of baseline were higher in SG rats than in control rats after exendin (9-39 administration (P<0.05. The levels of GLP-1 expression in the jejunum and ileum were higher in SG rats than in PF-sham and control rats (P<0.05. Conclusions. Improvement of glucose metabolism by SG was associated with increased GLP-1 secretion. SG contributes to an increase in plasma GLP-1 levels via increased GLP-1 expression in the mucosa of the jejunum and/or ileum.

  1. Comparison of staple-line leakage and hemorrhage in patients undergoing laparoscopic sleeve gastrectomy with or without Seamguard.

    Science.gov (United States)

    Simon, Todd E; Scott, Joshua A; Brockmeyer, Joel R; Rice, Robert C; Frizzi, James D; Husain, Farah A; Choi, Yong U

    2011-12-01

    Laparoscopic sleeve gastrectomy (LSG) has been recognized as a primary procedure for the surgical management of morbid obesity. Staple-line leaks and hemorrhage are two associated complications. Staple-line buttressing materials have been suggested to decrease these complications. When used during LSG, few published papers exist that compare the incidence of leak or hemorrhage to that of nonreinforced staple-lines. The purpose of this study was to compare the incidence of leak and hemorrhage in patients who did and did not receive reinforcement with Seamguard (W.L. Gore & Associates, Flagstaff, AZ). This is a retrospective analysis of patients undergoing LSG. All patients met National Institutes of Health criteria and each had an extensive preoperative evaluation. Data was collected from inpatient and outpatient medical records. Fifty-nine patients received reinforcement and 80 patients did not. There was no significant difference in mean body mass index, age, or gender make-up between the two groups. The overall incidence of leak was 3.60 per cent. The incidence was 3.39 per cent in patients who received reinforcement and 3.75 per cent in those who did not. This was not statistically significant. There was no incidence of staple-line hemorrhage in either group. There is no conclusive evidence that Seamguard reduces staple-line leakage or hemorrhage. Studies involving a larger number of patients are necessary before recommending staple-line reinforcement.

  2. Clinical evaluation of C-reactive protein and procalcitonin for the early detection of postoperative complications after laparoscopic sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Agata Frask

    2017-05-01

    Full Text Available Introduction : Among the most common early complications after bariatric surgery are anastomosis leak and bleeding. In order to react quickly and perform accurate treatment before the clinical signs appear, early predictors should be found. In the study C-reactive protein (CRP and procalcitonin (PCT levels were investigated. Characterized by a relatively short half-life, they can predict surgical complications. Aim : To develop and implement certain standards for early detection of complications. Material and methods : The study involved 319 adults who underwent laparoscopic sleeve gastrectomy (LSG as a surgical intervention for morbid obesity at the Department of General Surgery of Ceynowa Hospital in Wejherowo. Every patient had CRP and PCT levels measured before the surgery and on the 1st and 2nd postoperative day (POD. Results : Early postoperative complications occurred in 19 (5.96% patients. Septic and non-septic complications occurred in 3 and 16 patients respectively. Among the patients with septic postoperative complications CRP level increased significantly on the 2nd POD compared to the remainder (p = 0.0221. Among the patients with non-septic postoperative complications CRP level increased significantly on the 1st and 2nd POD compared to the remainder. Among the patients with septic and non-septic postoperative complications PCT level increased significantly on the 2nd POD compared to the remainder. Conclusions : The CRP and PCT level are supposed to be relevant diagnostic markers to predict non-septic and septic complications after LSG.

  3. Comparison of nutritional status during the first year after sleeve gastrectomy and Roux-en-Y gastric bypass.

    Science.gov (United States)

    Coupaye, Muriel; Rivière, Pauline; Breuil, Marie Christine; Castel, Benjamin; Bogard, Catherine; Dupré, Thierry; Flamant, Martin; Msika, Simon; Ledoux, Séverine

    2014-02-01

    Sleeve gastrectomy (SG) is supposed to induce fewer nutritional deficiencies than gastric bypass (GBP). However, few studies have compared nutritional status after these two procedures, and the difference in weight loss (WL) between procedures may alter the results. Thus, our aim was to compare nutritional status after SG and GBP in subjects matched for postoperative weight. Forty-three subjects who underwent SG were matched for age, gender, and 6-month postoperative weight with 43 subjects who underwent GBP. Dietary intakes (DI), metabolic (MP), and nutritional parameters (NP) were recorded before and at 6 and 12 months after both procedures. Multivitamin supplements were systematically prescribed after surgery. Before surgery, BMI, DI, MP, and NP were similar between both groups. After surgery, LDL cholesterol, serum prealbumin, vitamin B12, urinary calcium, and vitamin D concentrations were lower after GBP than after SG, whereas WL and DI were similar after both procedures. However, the total number of deficiencies did not increase after surgery regardless of the procedure. In addition, we found a significant increase in liver enzymes and a greater decrease in C-reactive protein after GBP. In conclusion, during the first year after surgery, in patients with the same WL and following the same strategy of vitamin supplementation, global nutritional status was only slightly impaired after SG and GBP. However, some nutritional parameters were specifically altered after GBP, which could be related to malabsorption or other mechanisms, such as alterations in liver metabolism.

  4. Determinants of Weight Loss following Laparoscopic Sleeve Gastrectomy: The Role of Psychological Burden, Coping Style, and Motivation to Undergo Surgery

    Directory of Open Access Journals (Sweden)

    Andrea Figura

    2015-01-01

    Full Text Available Background. The amount of excess weight loss (%EWL among obese patients after bariatric surgery varies greatly. However, reliable predictors have not been established yet. The present study evaluated the preoperative psychological burden, coping style, and motivation to lose weight as factors determining postoperative treatment success. Methods. The sample included 64 morbidly obese patients with a preoperative BMI of 51±8 kg/m2 who had undergone laparoscopic sleeve gastrectomy (LSG. Well-established questionnaires were applied before surgery to assess the psychological burden in terms of “perceived stress” (PSQ-20, “depression” (PHQ-9, “anxiety” (GAD-7, and “mental impairment” (ISR as well as coping style (Brief COPE and motivation to lose weight. %EWL as an indicator for treatment success was assessed on average 20 months after surgery. Results. Based on the %EWL distribution, patients were classified into three %EWL groups: low (14–39%, moderate (40–59%, and high (60–115%. LSG patients with high %EWL reported significantly more “active coping” behavior prior to surgery than patients with moderate and low %EWL. Patients’ preoperative psychological burden and motivation to lose weight were not associated with %EWL. Conclusion. An “active coping” style might be of predictive value for better weight loss outcomes in patients following LSG intervention.

  5. Differential Changes in Gut Microbiota After Gastric Bypass and Sleeve Gastrectomy Bariatric Surgery Vary According to Diabetes Remission.

    Science.gov (United States)

    Murphy, Rinki; Tsai, Peter; Jüllig, Mia; Liu, Amy; Plank, Lindsay; Booth, Michael

    2017-04-01

    It is unclear whether specific gut microbiota is associated with remission of type 2 diabetes (T2D) after distinct types of bariatric surgery. The aim of this study is to examine gut microbiota changes after laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgery in obese patients with T2D. Whole-metagenome shotgun sequencing of DNA fragments using Illumina HiSeq2000 was obtained from stool samples collected from 14 obese T2D patients pre-operatively (while on very low calorie diet) and 1 year after randomisation to laparoscopic SG (n = 7) or RYGB (n = 7). Resulting shotgun reads were annotated with Kyoto Encyclopedia of Genes and Genomes (KEGG). Body weight reduction and dietary change was similar 1 year after both surgery types. Identical proportions (n = 5/7) achieved diabetes remission (HbA1c surgery types. KEGG Orthology and pathway analysis predicted contrasting and greater gut microbiota metabolism changes after diabetes remission following RYGB than after SG. Those with persistent diabetes post-operatively had higher Desulfovibrio species pre-operatively. Overall, RYGB produces greater and more predicted favourable changes in gut microbiota functional capacity than SG. An increase in Roseburia species was the only compositional change common to both types of surgery among those achieving diabetes remission.

  6. Incidence of deep vein thrombosis and thrombosis of the portal-mesenteric axis after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Alsina, Ena; Ruiz-Tovar, Jaime; Alpera, Maria Remedios; Ruiz-García, Jose Gregorio; Lopez-Perez, Manuel Enrique; Ramon-Sanchez, Jose Francisco; Ardoy, Francisco

    2014-09-01

    Venous thromboembolism is the most common postoperative medical complication after bariatric surgery. Mortality associated with thromboembolic processes can reach up to 50%-75%. The aim of this study was to determine the incidence of deep vein thrombosis (DVT) and portal-splenic-mesenteric vein thrombosis (PSMVT) in our population undergoing laparoscopic sleeve gastrectomy (LSG) as the bariatric technique, with an anti-thromboembolic dosage scheme of 0.5 mg/kg/day 12 hours preoperatively and maintained during 30 days postoperatively. A prospective observational study was performed, including 100 consecutive patients undergoing LSG between October 2007 and September 2013. To determine the incidence of DVT and PSMVT, all patients undergo contrast-enhanced abdominal computed tomography (CT) and Doppler ultrasonography (US) of both lower limbs on the third postoperative month, whether they were asymptomatic or symptomatic. Contrast-enhanced CT showed 1 case of PSMVT (1%). Two patients presented DVT in the right leg (2%). All the cases were asymptomatic. The incidence of PSMVT and DVT after LSG with a prophylactic low-molecular-weight heparin dose of 0.5 mg/kg/day and maintained during 30 days postoperatively is 1% and 2%, respectively. According to these results, a postoperative screening with Doppler US and/or contrast-enhanced CT seems to be unnecessary.

  7. Combination of haloperidol, dexamethasone, and ondansetron reduces nausea and pain intensity and morphine consumption after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Benevides, Márcio Luiz; Oliveira, Sérgio de Souza; Aguilar-Nascimento, José Eduardo

    2013-01-01

    Postoperative nausea and vomiting (PONV) occur frequently after laparoscopic bariatric surgery. The combination of haloperidol, dexamethasone, and ondansetron may reduce these undesirable events. The aim of this study was to evaluate the intensity of nausea and pain, the number of vomiting episodes, and morphine consumption in postoperative (PO) obese patients undergoing laparoscopic sleeve gastrectomy (LSG). A clinical, randomized, controlled, double-blind study conducted with 90 patients with body mass index ≥ 35 kg.cm-2. Patients were divided into three groups of 30 individuals to receive ondansetron 8 mg (Group O); ondansetron 8 mg and dexamethasone 8 mg (Group OD); and ondansetron 8 mg, dexamethasone 8 mg, and haloperidol 2 mg (Group HDO). We evaluated the intensity of nausea and pain using the verbal numeric scale, cumulative number of vomiting episodes, and morphine consumption in the period of 0-2, 2-12, 12-24, and 24-36 hours postoperatively. Nausea intensity was lower in Group HDO compared to Group O (p = 0.001), pain intensity was lower in Group HDO compared to Group O (p = 0.046), and morphine consumption was lower in Group HDO compared to Group O (p = 0.037). There was no difference between groups regarding the number of vomiting episodes (p = 0.052). The combination of haloperidol, ondansetron, and dexamethasone reduced nausea and pain intensity and morphine consumption in postoperative obese patients undergoing LSG.

  8. Clinical evaluation of C-reactive protein and procalcitonin for the early detection of postoperative complications after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Frask, Agata; Orłowski, Michał; Dowgiałło-Wnukiewicz, Natalia; Lech, Paweł; Gajewski, Krzysztof; Michalik, Maciej

    2017-06-01

    Among the most common early complications after bariatric surgery are anastomosis leak and bleeding. In order to react quickly and perform accurate treatment before the clinical signs appear, early predictors should be found. In the study C-reactive protein (CRP) and procalcitonin (PCT) levels were investigated. Characterized by a relatively short half-life, they can predict surgical complications. To develop and implement certain standards for early detection of complications. The study involved 319 adults who underwent laparoscopic sleeve gastrectomy (LSG) as a surgical intervention for morbid obesity at the Department of General Surgery of Ceynowa Hospital in Wejherowo. Every patient had CRP and PCT levels measured before the surgery and on the 1 st and 2 nd postoperative day (POD). Early postoperative complications occurred in 19 (5.96%) patients. Septic and non-septic complications occurred in 3 and 16 patients respectively. Among the patients with septic postoperative complications CRP level increased significantly on the 2 nd POD compared to the remainder (p = 0.0221). Among the patients with non-septic postoperative complications CRP level increased significantly on the 1 st and 2 nd POD compared to the remainder. Among the patients with septic and non-septic postoperative complications PCT level increased significantly on the 2 nd POD compared to the remainder. The CRP and PCT level are supposed to be relevant diagnostic markers to predict non-septic and septic complications after LSG.

  9. The effects of bariatric surgical procedures on the improvement of metabolic syndrome in morbidly obese patients: Comparison of laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass.

    Science.gov (United States)

    Kafalı, Mehmet Ertuğrul; Şahin, Mustafa; Ece, İlhan; Acar, Fahrettin; Yılmaz, Hüseyin; Alptekin, Hüsnü; Ateş, Leyla

    2017-01-01

    The objective of this study was to evaluate patients who underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in terms of weight loss, metabolic parameters, and postoperative complications. Data on patients who underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy with a diagnosis of morbid obesity between January 2012 and June 2014 were retrospectively evaluated. Patients were compared in terms of age, sex, body mass index, duration of operation, American Society of Anesthesiologists score, perioperative complications, length of hospital stay, and long term follow-up results. During the study period, 91 patients (45 laparoscopic Roux-en-Y gastric bypass and 46 laparoscopic sleeve gastrectomy) underwent bariatric surgery. There was no difference between the two groups in terms of preoperative patient characteristics. Both groups showed statistically significant weight loss and improvement in co-morbidities when compared with the preoperative period. Weight loss and improvement in metabolic parameters were similar in both groups. The duration of operation and hospital stay was longer in the laparoscopic Roux-en-Y gastric bypass group. Furthermore, the rate of total complications was significantly lower in the laparoscopic sleeve gastrectomy group. Laparoscopic sleeve gastrectomy is a safe and effective method with a significantly lower complication rate and length of hospital stay than laparoscopic Roux-en-Y gastric bypass, with similar improvement rates in metabolic syndrome.

  10. A Case Study of Severe Esophageal Dysmotility following Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Caroline E. Sheppard

    2016-01-01

    Full Text Available Following bariatric surgery, a proportion of patients have been observed to experience reflux, dysphagia, and/or odynophagia. The etiology of this constellation of symptoms has not been systematically studied to date. This case describes a 36-year-old female with severe esophageal dysmotility following LSG. Many treatments had been used over a course of 3 years, and while calcium channel blockers reversed the esophageal dysmotility seen on manometry, significant symptoms of dysphagia persisted. Subsequently, the patient underwent a gastric bypass, which seemed to partially relieve her symptoms. Her dysphagia was no longer considered to be associated with a structural cause but attributed to a “sleeve dysmotility syndrome.” Considering the difficulties with managing sleeve dysmotility syndrome, it is reasonable to consider the need for preoperative testing. The question is whether motility studies should be required for all patients planning to undergo a LSG to rule out preexisting esophageal dysmotility and whether conversion to gastric bypass is the preferred method for managing esophageal dysmotility after LSG.

  11. Comparing quality of life outcomes between Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass using the RAND36 questionnaire.

    Science.gov (United States)

    Macano, Christina A W; Nyasavajjala, Sitaramachandra M; Brookes, Alastair; Lafaurie, Guillaume; Riera, Manel

    2017-06-01

    Obesity surgery is an effective treatment to improve the health of patients. There is a lack of data regarding weight loss surgery outcomes and effects on Quality of Life (QoL). This study aims to compare changes in QoL following either Laparoscopic Sleeve Gastrectomy (LSG) or Laparoscopic Roux-en-Y Gastric Bypass (LRYGB). SF36 questionnaires were mailed to all LSG and LRYGB patients who underwent surgery in 2013. Demographic data was obtained from hospital records. Statistical analysis was undertaken using Stats direct. 158 patients were sent postal questionnaires. 60 were returned (38%). 41 were women, 16 LSG, 44 LRYGB, mean age 52 years, mean BMI pre-surgery 41.0. Both procedures yielded similar weight loss over 2 year follow up (p = 0.01), and similar improvements in obesity related co-morbidities. These procedures yielded significant improvements in all QoL scales and domains other than the emotional role limitations scale following sleeve gastrectomy. Bariatric surgery has been shown to improve a patient's QoL. More research is needed to explain the reasons why there was a difference between Sleeve and Bypass procedures in emotional changes to patients. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  12. Five-Year-Results of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass for Weight Loss and Type 2 Diabetes Mellitus.

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    Seki, Yosuke; Kasama, Kazunori; Haruta, Hidenori; Watanabe, Atsushi; Yokoyama, Renzo; Porciuncula, Jose Paolo Cabreira; Umezawa, Akiko; Kurokawa, Yoshimochi

    2017-03-01

    Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) has been designated as a novel bariatric surgery procedure. This combination of sleeve gastrectomy and proximal intestinal bypass theoretically offers an effective and prolonged anti-diabetes effect. This is a follow-up of our institution's previous report on the short-term effects of LSG-DJB on type 2 diabetes mellitus (T2DM), which a 68.7 % remission (HbA1c surgery. The aforementioned result was comparable to the reported remission rates of laparoscopic Roux-en-Y gastric bypass. However, the durability of remission remains unknown. The objective of this study is to investigate the medium-term (up to 5 years) effects of LSG-DJB on weight loss and T2DM. In this analysis, consecutive 120 patients (female to male ratio = 61:59, mean age = 44.8 years) with T2DM who underwent LSG-DJB from April 2007 to November 2013 and were followed up beyond 1 year were included. The preoperative mean body weight and BMI were 105.7 kg and 38.5 kg/m 2 , respectively. The mean HbA1c and fasting blood glucose values were 8.9 % and 194 mg/dL, respectively. The mean duration of T2DM was 7.3 years. Fifty-five patients (46 %) were being treated with insulin prior to surgery. The follow-up rate was 97.5 % at 1 year, 73.3 % at 3 years, and 50.0 % at 5 years. The mean body weight was 74.9 kg at 1 year, 76.8 kg at 3 years, and 72.8 kg at 5 years (p < 0.001, compared to the baseline). The mean percent of total body weight loss (%TWL) was 28.9, 28.6, and 30.7 % at 1, 3, and 5 years, respectively. Remission of T2DM was achieved at 63.6, 55.3, and 63.6 % at 1, 3, and 5 years, respectively. Among those who achieved diabetes remission at 1 year, 10.8 % of them experienced recurrence during the subsequent follow-up period. Although recurrence of T2DM is observed in some patients over time, LSG-DJB is an effective procedure for achieving significant weight loss and improvement of glycemic control, and

  13. Effects of Laparoscopic Sleeve Gastrectomy on Central Obesity and Metabolic Syndrome in Indian Adults- A Prospective Study.

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    Sethi, Pulkit; Thillai, Manoj; Nain, Prabhdeep Singh; Ahuja, Ashish; Vayoth, Sudheer Othiyil; Khurana, Preetika

    2017-01-01

    Increasing incidence of obesity in Indian population has led to an exponential rise in the number of bariatric operations performed annually. Laparoscopic Sleeve Gastrectomy (LSG) has been proposed to cause rapid remission of Type 2 Diabetes Melitus (T2DM) and metabolic syndrome in a weight loss independent manner. To evaluate the effects of LSG on metabolic syndrome and central obesity in morbidly and severely obese Indian adults. Material and Methods: Study was conducted on 91 morbidly obese [Body Mass Index (BMI)>40 kg/m 2 ] and severely obese (BMI>35 kg/m 2 ) individuals who were suffering from diabetes, hypertension or dyslipidemia. The patients were followed up for six months and the trends of glycaemic control, mean blood pressure, lipid profile, weight loss parameters and changes in parameters of central obesity were studied. Weight loss was significant at three months postsurgery and was sustained through six months. There was significant improvement in glycaemic control leading to reduction in need for oral hypoglycaemic agents or insulin in majority of them and even discontinuation of these medications in few patients. Hypertension and dyslipidemia also showed an improving trend through six months postsurgery. There was a significant impact on reduction of central obesity in these patients as marked by significant reduction in waist to hip ratio. LSG produces sustainable weight loss with significant improvement in glycaemic status and control of metabolic syndrome in severe to morbidly obese patients. LSG is also efficacious in reducing central obesity in Indian population which is a major depressive ailment amongst obese individuals.

  14. Does Weight Gain During the Operation Wait Time Have an Impact on Weight Loss After Laparoscopic Sleeve Gastrectomy?

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    Cayci, Haci Murat; Erdogdu, Umut Eren; Karaman, Kerem; Budak, Ersin; Taymur, İbrahim; Buyukuysal, Cagatay

    2017-02-01

    The effect of preoperative weight changes on postoperative outcomes after bariatric surgery remains inconclusive. The aim of the present study was to evaluate the effect of preoperative weight gain on postoperative weight loss outcomes after laparoscopic sleeve gastrectomy (SG). Ninety-two morbidly obese patients undergoing SG from January 2014 to April 2016 were separated into two groups according to whether they gained weight or not during the waiting time prior to surgery. Thirty-nine patients (42.4 %) gained weight during the waiting time and 53 patients (57.6 %) did not. The median body mass index (BMI; kg/m 2 ) at surgery was significantly higher in weight-gained patients (47.8 (min-max, 40-62)) compared to patients who had not gained weight (45.10 (min-max, 41-67)), (P = 0.034). No significant difference was found between the two groups regarding the distribution of age, gender, family history of obesity, existence of comorbidity, smoking, weight gain during childhood or adulthood, preoperative Beck depression and Beck anxiety scores, waiting time period, and body weight at the initial visit (P > 0.05). The ASA I score was higher in weight-gained patients whereas ASA II score was higher in those who did not gain, and the difference was significant (P = 0.046). Postoperative % BMI loss and % weight loss were not significantly different between the two groups at the first, third, sixth months, and the end of the first year (P > 0.05). Weight gain during waiting time has no negative impact on % weight loss and % BMI loss after SG.

  15. Alterations of Gut Microbiota After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Sprague-Dawley Rats.

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    Shao, Yikai; Ding, Rui; Xu, Bo; Hua, Rong; Shen, Qiwei; He, Kai; Yao, Qiyuan

    2017-02-01

    The objective of the study was to compare gut microbiota post Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Sprague-Dawley rats were randomized to RYGB, SG, or sham surgery. Body weight was measured. Fecal samples were collected before and 1, 3, 6, and 9 weeks postoperatively. Fecal microbiota was profiled by 16S ribosomal DNA gene sequencing and analyzed using Quantitative Insights into Microbial Ecology (QIIME) to determine the α and β diversities of gut microbiota. The body weight of the RYGB and SG group was significantly lower than that of the sham group. Unweighted UniFrac-based principal coordinate analysis of 5,323,091 sequences from 85 fecal samples from 17 rats revealed a distinct cluster of gut microbiota post RYGB from SG and sham surgery. The percentage of Proteobacteria in the SG and sham group remained markedly lower than that of the RYGB group from 3 weeks postoperatively, while the proportion of Gammaproteobacteria in the RYGB group was significantly higher than that of the SG group and the sham group from 3 weeks postoperatively. Furthermore, the RYGB group was postoperatively enriched for Gammaproteobacteria and Bacteroidaceae, whereas the SG group was postoperatively enriched for Desulfovibrionaceae and Cyanobacteria. Compared to the pre-operative parameters, the RYGB group had a persistent increase in the relative abundance of Gammaproteobacteria and a decrease in the Shannon index, while the SG group only transiently exhibited these changes within the first week after surgery. The relative abundance of Gammaproteobacteria was negatively correlated, whereas the Shannon index was positively correlated with weight after surgery. RYGB, but not SG, alters the gut microbiota of Sprague-Dawley rats. RYGB also reduces the diversity of gut microbiota. Furthermore, the abundance of Gammaproteobacteria negatively correlates with postoperative body weight and may be one of the potential contributors to stable weight loss after

  16. Effect of Roux-en-Y gastric bypass and sleeve gastrectomy on nonalcoholic fatty liver disease: a comparative study.

    Science.gov (United States)

    Froylich, Dvir; Corcelles, Ricard; Daigle, Christopher; Boules, Mena; Brethauer, Stacy; Schauer, Philip

    2016-01-01

    Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in the United States; 85%-95% of the morbidly obese population have NAFLD and 33% have nonalcoholic steatohepatitis. There is a lack of comparative data assessing various bariatric procedures and their effect on NAFLD. To assess and compare the effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on NAFLD. Academic Center, United States All bariatric cases performed at the authors' institution (an academic center in the United States) between 2005 and 2012 that had both intraoperative and postoperative liver biopsies were included. NAFLD Activity Score (NAS) and fibrosis stages were used to evaluate improvement in liver histology. Fourteen RYGB and 9 SG patients with liver biopsies were identified. 57% and 73% in each group were female, respectively. P = .2. RYGB patients were older (56.2 ± 8.6 versus 46.3 ± 11.7; PRYGB and SG, respectively (P value not significant). Percentage of excess weight loss was higher in RYGB patients (69.8% ± 27% versus 37.2% ± 12.3%; PRYGB significantly improved in all morphologic characteristics, whereas only steatosis and total NAS improved after SG. Fibrosis state improved in both groups but to a greater degree after RYGB (2.5 ± 1.3 versus .3 ± .6; PRYGB and SG procedures, although the baseline characteristics of the groups differ. This exploratory data supports the idea of conducting a randomized trial to determine the differential effects of SG and RYGB on NAFLD. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  17. Staple line leak with peritonitis after laparoscopic sleeve gastrectomy – a solution in one to six steps

    Directory of Open Access Journals (Sweden)

    Petr Špička

    2017-06-01

    Full Text Available Introduction: Laparoscopic sleeve gastrectomy (LSG is one of the most efficient bariatric interventions in morbidly obese patients. The most severe risk of this procedure seems to be the staple line leak, and the management of this complication can be very arduous. Aim : To share our experience in managing the staple line leak after LSG and to help to find the best procedure that should be preferred. Material and methods : In the 2010–2015 period we performed 223 LSG, with about 5 demonstrating severe complications – two patients with severe bleeding requiring revision surgery, and three patients with resection surface leak. Results : We always primarily treated the staple line leak with a laparoscopic revision. Once the fistula did not spontaneously close after this treatment. A series of other methods were then indicated for this patient and only the sixth one resulted in the desirable therapeutic success. At first, our team opted for laparoscopic revision with drainage. The next procedure involved applying Ovesco and Boston clips. As a third method we performed abscess drainage through a nasobiliary tube inserted via gastroscopy. Due to failure we performed the second laparoscopic revision with staple line resuture, the next intervention was an open revision with fistula excision and suture, and finally we opted for the application of a self-expanding metallic stent, which proved to be definitely curative. Conclusions : Without any guidelines it is very difficult to determine the right procedure addressing the staple line leak after LSG. It depends mainly on the clinician’s experience and is lengthy and often untraditional.

  18. Reasons and outcomes of conversion of laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass for nonresponders.

    Science.gov (United States)

    Abdemur, Abraham; Han, Sang-Moon; Lo Menzo, Emanuele; Szomstein, Samuel; Rosenthal, Raul

    2016-01-01

    Laparoscopic sleeve gastrectomy (LSG) as a primary bariatric procedure has gained significant popularity. Conversion to Roux-en-Y gastric bypass (RYGBP) or Roux-en-Y esophagojejunostomy (LRYEJ) has been described as a treatment option for inadequate weight loss after LSG and unresolved co-morbidities or complications such as leak, stricture, and severe gastroesophageal reflux disease (GERD). To determine reasons and outcomes of conversions of LSG to RYGBP. Academic Center of Excellence Between January 2004 and August 2014, a total of 1118 patients underwent primary LSG for morbid obesity. A retrospective review of a prospectively collected database was conducted for laparoscopic conversions of LSG to RYGBP or LRYEJ, describing reasons and outcomes. Conversion to RYGBP was identified in 30 (2.7%) patients, of whom only 9 (0.8%) were originally from the authors' institution. Of the entire cohort of revisions, 9 (0.8%) had intractable GERD; only 4 (0.4% of total LSGs reviewed) were originally from the authors' institution. Seven (0.6%) patients were revised for inadequate weight loss: 5 (0.4%) originally from the authors' institution, 2 (0.2%) for stricture, and 12 (1.1%) for leak. Both the stricture and the leak patients were referred from outside institutions. All procedures were performed laparoscopically. The additional mean excess weight loss after conversion to RYGBP was 30.9% with no mortalities. The most common reason for conversion was chronic leak. The conversion rate of LSG to RYGBP due to inadequate weight loss, GERD, and stricture was 1.6% for the entire group, with .8% from the authors' institution. Additional follow-up and studies are needed to define real incidence of GERD after LSG. Copyright © 2016. Published by Elsevier Inc.

  19. Comparison of laparoscopic sleeve gastrectomy to laparoscopic Roux-en-Y gastric bypass for morbid obesity in a military institution.

    Science.gov (United States)

    Lim, David M; Taller, Janos; Bertucci, William; Riffenburgh, Robert H; O'Leary, Jack; Wisbach, Gordon

    2014-01-01

    Laparoscopic sleeve gastrectomy (LSG) is gaining acceptance in the bariatric community as a definitive weight loss procedure; however, longitudinal data remain limited. The objective of this study was to compare weight loss results of LSG with laparoscopic Roux-en-Y gastric bypass (LRYGB) up to 5 years postoperatively using anthropometric measurements. Prospectively collected bariatric database at the Naval Medical Center San Diego was retrospectively reviewed from 2005-2011 . Anthropometric factors, including weight and hip circumference were measured during standard yearly follow-up appointments. Surgical outcomes were tested by the Student t test and demographic variables by Fisher's exact and Wilcoxon rank-sum tests. Follow-up was achieved in 147/226 LRYGB versus 130/208 LSG at year 1, 92/195 versus 81/151 at year 2, 64/145 versus 50/100 at year 3, 32/81 versus 18/54 at year 4, and 12/42 versus 14/15 at year 5. The excess weight loss (EWL) for LRYGB versus LSG was 72% versus 64.7% at 1 year (P = .002), 71.3% versus 65.5% at 2 years (P = .113), and 68.3% versus 57.4% at 5 years (P = .252), respectively. Similarly, the body mass index (BMI) decrease was statistically significant at 1 year (P = .001) but not on subsequent annual visits. Mean percent body adiposity index (BAI) decrease was 28.4% for LRYGB versus 26.8% for LSG at 1 year (P = .679) and 21.8% versus 29.8% at 2 years (P = .134), respectively. Weight loss measured in terms of %EWL and decrease in BMI and BAI did not show significance between LRYGB and LSG 2 years after surgery. Our study provides similar long-term weight loss between LSG and LRYGB, and therefore, LSG is a viable option as a definitive bariatric procedure. Published by Elsevier Inc.

  20. Three-Year Outcomes of Revisional Laparoscopic Gastric Bypass after Failed Laparoscopic Sleeve Gastrectomy: a Case-Matched Analysis.

    Science.gov (United States)

    Malinka, Thomas; Zerkowski, Jens; Katharina, Itskovich; Borbèly, Yves Michael; Nett, Philipp; Kröll, Dino

    2017-09-01

    While previous studies suggest laparoscopic Roux-en-Y gastric bypass (LRYGB) as a reasonable treatment approach to address weight loss failure after laparoscopic sleeve gastrectomy (LSG), data focusing on long-term outcomes are still lacking. The purpose of this study was to evaluate weight and comorbidity outcomes comparing revisional LRYGB (rLRYGB) with primary LRYGB (pLRYGB). Retrospective single-centre case-matched analysis was conducted at a bariatric tertiary referral centre. Between January 2009 and July 2013, 239 patients were entered into a prospective database, and 32 patients undergoing rLRYGB (cases) were matched with 32 patients undergoing pLRYGB (controls) for sex, age and BMI. The end point was data at 3 years of follow-up. Thirty-one patients (12.9%) were lost to follow-up during the study period. There were no significant differences in patient demographics or median BMI (kg/m 2 ) for pLRYGB or rLRYGB (42.8 ± 12.1 vs. 42.3 ± 11.5, respectively; p = 0.748). Coexisting comorbidities were rated similarly in both groups. At 3 years, the percentage of excess weight loss (74.4 ± 23.3 vs 52.0 ± 26, respectively; p = 0.007) was higher for pLRYGB than rLRYGB, while similar improvements of coexisting comorbidities could be observed. rLRYGB is a feasible and practical surgical approach that allows effective weight loss at 3 years of follow-up and alleviates refractory reflux symptoms. Although weight loss is lower compared to pLRYGB, resolution or improvement of coexisting comorbidities appears similar. Therefore, rLRYGB seems to be a reliable procedure to address failure after LSG.

  1. Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch.

    Science.gov (United States)

    Homan, Jens; Betzel, Bark; Aarts, Edo O; van Laarhoven, Kees J H M; Janssen, Ignace M C; Berends, Frits J

    2015-01-01

    Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain and other complications are reported. Demand for secondary surgery is rising, partly for these reasons. To review the indications and effects of secondary surgery, biliopancreatic diversion with duodenal switch (BPD/DS) versus laparoscopic Roux-en-Y gastric bypass (LRYGB), after LSG. Data from all patients who underwent revision of LSG was retrospectively analyzed, concerning data on indications for secondary surgery, weight loss, and complications. 43 Patients underwent secondary surgery after LSG; 25 BPD/DS and 18 LRYGB, respectively. Main indications for secondary surgery were inadequate weight loss (n = 17 [40%]) and weight regain (n = 8 [19%]). For these indications, the median excess weight loss was greater for BPD/DS (59% [range 15-113]) compared to LRYGB (23% [range -49-84]) (P = .008) after 34 months (range 14-79). In case of dysphagia or gastroesophageal reflux disease the complaints resolved after converting to LRYGB. BPD/DS patients were more likely to develop a short-term complication and vitamin deficiencies compared to LRYGB. Secondary surgery of LSG to BPD/DS or LRYGB is feasible with slightly more complications after BPD/DS. Conversion to LRYGB is preferred in cases of dysphagia or gastroesophageal reflux disease. In cases of weight regain or insufficient weight loss after LSG, patients had better weight loss with a BPD/DS; however, this procedure has the risk of complications, such as severe vitamin deficiencies. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  2. Efficacy of laparoscopic sleeve gastrectomy and intensive medical management in obese patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Palikhe, Gaurav; Gupta, Rajesh; Behera, B N; Sachdeva, Naresh; Gangadhar, Prathosh; Bhansali, Anil

    2014-04-01

    There are a dearth of studies comparing laparoscopic sleeve gastrectomy (LSG) and intensive medical treatment (IMT) in obese type 2 diabetes mellitus (T2DM) patients. This study compares these modalities in terms of weight loss, metabolic parameters and quality of life (QOL) score. We evaluated the efficacy of LSG (n = 14) vs. IMT (n = 17) comprising of low calorie diet, exenatide, metformin and if required insulin detemir in 31 obese T2DM patients with BMI of 37.9 ± 5.3kg/m(2) and target HbA1c diabetes was 8.5 ± 6.1 years and mean HbA1c was 8.6 ± 1.3 %. Primary end point was excess body weight loss (EBWL) at the final follow-up. The mean duration of follow-up was 12.5 ± 5.0 (median 12) months. EBWL was 61.2 ± 17.6 % and 27.4 ± 23.6 % in LSG and IMT group respectively (p diabetes and hypertension in 36 and 29 % of patients respectively while none in the IMT group. HOMA-IR, hsCRP, ghrelin and leptin decreased while adiponectin increased significantly in LSG compared to IMT group. QOL score improved in LSG as compared to IMT. In obese T2DM patients, LSG is superior to IMT in terms of weight loss, resolution of comorbidities and QOL score.

  3. Low Educational Status and Childhood Obesity Associated with Insufficient Mid-Term Weight Loss After Sleeve Gastrectomy: a Retrospective Observational Cohort Study.

    Science.gov (United States)

    Dilektasli, Evren; Erol, Mehmet Fatih; Cayci, Haci Murat; Ozkaya, Guven; Bayam, Mehmet Emrah; Duman, Ugur; Tihan, Necdet D; Erdogdu, Umut; Kisakol, Gurcan

    2017-01-01

    Successful weight loss after bariatric surgery has been associated with a variety of factors. The aim of this study was to determine the effects of educational status on surgical weight loss for patients undergoing sleeve gastrectomy (SG). This retrospective cohort study was carried out on patients undergoing SG between September 2013 and July 2015. Six months after surgery, the patients were classified into two groups according to their success in the percentage of excess weight loss (%EWL). Group 1: bariatric surgery population.

  4. Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy to Treat Morbid Obesity-Related Comorbidities: a Systematic Review and Meta-analysis.

    Science.gov (United States)

    Li, Jianfang; Lai, Dandan; Wu, Dongping

    2016-02-01

    Our aim was to compare laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) for treating morbid obesity and its related comorbidities. An electronic literature search was performed from inception to May 2015 and a total of 18,455 patients, enrolled in 62 recent studies, were included in this meta-analysis. Patients receiving LRYGB had a significantly higher percentage of excess weight loss and better resolution of hypertension, dyslipidemia, gastroesophageal reflux disease, and arthritis compared with those receiving LSG. LRYGB and LSG showed similar effects on type 2 diabetes mellitus and sleep apnea.

  5. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial.

    Science.gov (United States)

    Salminen, Paulina; Helmiö, Mika; Ovaska, Jari; Juuti, Anne; Leivonen, Marja; Peromaa-Haavisto, Pipsa; Hurme, Saija; Soinio, Minna; Nuutila, Pirjo; Victorzon, Mikael

    2018-01-16

    Laparoscopic sleeve gastrectomy for treatment of morbid obesity has increased substantially despite the lack of long-term results compared with laparoscopic Roux-en-Y gastric bypass. To determine whether laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass are equivalent for weight loss at 5 years in patients with morbid obesity. The Sleeve vs Bypass (SLEEVEPASS) multicenter, multisurgeon, open-label, randomized clinical equivalence trial was conducted from March 2008 until June 2010 in Finland. The trial enrolled 240 morbidly obese patients aged 18 to 60 years, who were randomly assigned to sleeve gastrectomy or gastric bypass with a 5-year follow-up period (last follow-up, October 14, 2015). Laparoscopic sleeve gastrectomy (n = 121) or laparoscopic Roux-en-Y gastric bypass (n = 119). The primary end point was weight loss evaluated by percentage excess weight loss. Prespecified equivalence margins for the clinical significance of weight loss differences between gastric bypass and sleeve gastrectomy were -9% to +9% excess weight loss. Secondary end points included resolution of comorbidities, improvement of quality of life (QOL), all adverse events (overall morbidity), and mortality. Among 240 patients randomized (mean age, 48 [SD, 9] years; mean baseline body mass index, 45.9, [SD, 6.0]; 69.6% women), 80.4% completed the 5-year follow-up. At baseline, 42.1% had type 2 diabetes, 34.6% dyslipidemia, and 70.8% hypertension. The estimated mean percentage excess weight loss at 5 years was 49% (95% CI, 45%-52%) after sleeve gastrectomy and 57% (95% CI, 53%-61%) after gastric bypass (difference, 8.2 percentage units [95% CI, 3.2%-13.2%], higher in the gastric bypass group) and did not meet criteria for equivalence. Complete or partial remission of type 2 diabetes was seen in 37% (n = 15/41) after sleeve gastrectomy and in 45% (n = 18/40) after gastric bypass (P > .99). Medication for dyslipidemia was discontinued in 47% (n

  6. Early post-operative weight loss after laparoscopic sleeve gastrectomy correlates with the volume of the excised stomach and not with that of the sleeve! Preliminary data from a multi-detector computed tomography-based study.

    Science.gov (United States)

    Pawanindra, Lal; Vindal, Anubhav; Midha, Manoj; Nagpal, Prashant; Manchanda, Alpana; Chander, Jagdish

    2015-10-01

    Pre- and post-operative stomach volumes can be important determinants for effectiveness of laparoscopic sleeve gastrectomy (LSG) in causing weight loss. There is little existing data on the volumes of stomach preoperatively and that excised during LSG. This study was designed to evaluate the change in gastric volume after LSG using multi-detector CT and to correlate it with early post-operative weight loss. Twenty consecutive patients with BMI ≥ 40 kg/m(2) and medical comorbidities underwent LSG between October 2011 and October 2013 and were analysed prospectively. The pre-operative stomach volume was measured by MDCT done 1-3 days before the surgery. LSG was performed in the standard manner using a 36F bougie. The volume of excised stomach was measured by distending the specimen with saline. MDCT of the upper abdomen was repeated 3 months postoperatively to calculate the gastric sleeve volume. Weight loss and resolution of comorbidities were documented. The mean pre-operative weight of patients was 123.90 kg, and the mean pre-operative stomach volume on MDCT was 1,067 ml. The stomach volume on pre-operative MDCT correlated with pre-operative weight and BMI. The mean volume of the excised stomach was 859 ml when measured by distension of the specimen and 850 ml on MDCT. After 3 months post surgery, the mean volume of gastric sleeve on MDCT was 217 ml, and the mean weight of the patients was 101.22 kg. The volume of the excised stomach calculated by MDCT correlated with the weight loss achieved 3 months postoperatively. However, no correlation was seen between the gastric sleeve volume 3 months postoperatively and weight loss during this period. MDCT is a good method to measure gastric volume before and after LSG. Early post-operative weight loss (3 months) correlates well with the volume of the excised stomach but not with that of the gastric sleeve.

  7. Laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG): short-term result and comparison with gastric bypass.

    Science.gov (United States)

    Lee, Wei-Jei; Lee, Kuo-Ting; Kasama, Kazunori; Seiki, Yosuke; Ser, Kong-Han; Chun, Shu-Chun; Chen, Jung-Chien; Lee, Yi-Chih

    2014-01-01

    Laparoscopic duodeno-jejunal bypass with sleeve gastrectomy (DJB-SG) has been introduced as a novel metabolic surgery from Asia recently. It provides benefits of avoiding the risk of remnant gastric cancer, minimization of malnutrition from duodenal switch. Here, we introduce the technique of single-loop anastomosis duodeno-jejunal bypass with sleeve gastrectomy (SADJB-SG) and compare with other gastric bypass surgeries. Fifty morbid obese patients underwent our novel procedure, laparoscopic SADJB-S from 2011 to 2013. Operative complication, weight loss, and diabetes remission were followed. All procedures were completed laparoscopically. The mean operative time was 181.7 ± 38.4 min, and the mean hospital stay was 3.8 days. Three minor early complications (6 %) were encountered but no major complication was noted. There was no significant difference in perioperative parameters between the SADJB-SG and gastric bypass except a longer operation time. The mean BMI decreased from 38.4 to 25.4 at 1 year after surgery with a mean weight loss of 32.7 % which is higher than gastric bypass. Laparoscopic SADJB-SG appears to be an ideal metabolic/bariatric surgery, whereas the efficacy is non-inferior to gastric bypass.

  8. Self-esteem and quality of life in adolescents with extreme obesity in Saudi Arabia: the effect of weight loss after laparoscopic sleeve gastrectomy.

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    Aldaqal, Saleh M; Sehlo, Mohammad G

    2013-01-01

    To evaluate the self-esteem and quality of life in adolescents with extreme obesity before and one year after laparoscopic sleeve gastrectomy as obesity is a major challenging medical problem, not only in adults but also in children and adolescents in Saudi Arabia. In a prospective cohort study, 32 adolescents (aged 13-17 years) with extreme obesity (Group 1) presenting for laparoscopic sleeve gastrectomy (LSG) were compared with 32 matched, healthy, nonobese adolescents (aged 14-17 years) (Group 2) with regards to self-esteem and quality of life. Assessment was done using the Rosenberg Self-Esteem Scale and Pediatric Quality of Life Inventory version 4.0 (self- and parent report), respectively. Body mass index (BMI) Z scores were calculated for both groups. We found significantly poor self-esteem and impairment in all domains of quality of life (self- and parent report) in Group 1 compared with Group 2 (PSelf esteem and quality of life (self- and parent reports) significantly improved 1 year after LSG (Pself-esteem (R2=0.28 and P=.003) and quality of life (R(2)=0.67 and Padolescents with extreme obesity: LSG leads to weight loss, with subsequent improvement in self-esteem and quality of life. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Effects of Roux-en-Y gastric bypass and sleeve gastrectomy on bone mineral density and marrow adipose tissue.

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    Bredella, Miriam A; Greenblatt, Logan B; Eajazi, Alireza; Torriani, Martin; Yu, Elaine W

    2017-02-01

    Bariatric surgery is associated with bone loss but skeletal consequences may differ between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the two most commonly performed bariatric procedures. Furthermore, severe weight loss is associated with high marrow adipose tissue (MAT); however, MAT is also increased in visceral adiposity. The purpose of our study was to determine the effects of RYGB and SG on BMD and MAT. We hypothesized that both bariatric procedures would lead to a decrease in BMD and MAT. We studied 21 adults with morbid obesity (mean BMI 44.1±5.1kg/m 2 ) prior to and 12months after RYGB (n=11) and SG (n=10). All subjects underwent DXA and QCT of the lumbar spine and hip to assess aBMD and vBMD. Visceral (VAT) and subcutaneous (SAT) adipose tissue was quantified at L1-L2. MAT of the lumbar spine and femur was assessed by 1H-MR spectroscopy. Calcitropic hormones and bone turnover markers were determined. At 12months after surgery, mean weight and abdominal fat loss was similar between the RYGB and SG groups. Mean serum calcium, 25(OH)-vitamin D, and PTH levels were unchanged after surgery and within the normal range in both groups. Bone turnover markers P1NP and CTX increased within both groups and P1NP increased to a greater extent in the RYGB group (p=0.03). There were significant declines from baseline in spine aBMD and vBMD within the RYGB and SG groups, although the changes were not significantly different between groups (p=0.3). Total hip and femoral neck aBMD by DXA decreased to a greater extent in the RYGB than the SG group (p0.2). MAT content of the lumbar spine and femoral diaphysis did not change from baseline in the RYGB group but increased after SG (p=0.03). Within the SG group, 12-month change in weight and VAT were positively associated with 12-month change in MAT (pRYGB and SG are associated with declines in lumbar spine BMD, however, the changes are not significantly different between the groups. RYGB may be associated with

  10. Predictors of readmission after laparoscopic gastric bypass and sleeve gastrectomy: a comparative analysis of ACS-NSQIP database.

    Science.gov (United States)

    Khorgami, Zhamak; Andalib, Amin; Aminian, Ali; Kroh, Matthew D; Schauer, Philip R; Brethauer, Stacy A

    2016-06-01

    Readmission rate is an indicator of quality in surgical practice. We aimed to determine the predictors of unplanned early readmissions following stapling bariatric surgeries. From the American College of Surgeons National Surgical Quality Improvement Program database, we identified morbidly obese patients, who underwent either laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) in 2012 and 2013. Demographic, comorbidities, operative and postoperative parameters of the readmitted (within 30 days) and non-readmitted patients were evaluated using a multivariate logistic regression analysis. A total of 35,655 patients (17,101 LSG and 18,554 LRYGB) were analyzed. Of those, 1758 patients (4.9 %) were readmitted within 30 days of surgery. Multivariate analysis showed the following significant predictors for readmission: Non-Hispanic black ethnicity (OR: 1.56, 95 % CI:1.34-1.81), Hispanic ethnicity (OR: 1.29, 95 % CI:1.05-1.58), totally or partially dependent functional status (OR: 1.94, 95 % CI:1.06-3.55), higher preoperative creatinine (OR: 1.13, 95 % CI:1.04-1.22), lower serum albumin (OR: 0.78, 95 % CI:0.68-0.90), diabetes mellitus on insulin (OR: 1.28, 95 % CI:1.09-1.51), steroid or immunosuppressant use for a chronic condition (OR: 1.61, 95 % CI:1.11-2.33), history of cardiac disease with intervention (OR: 2.05, 95 % CI:1.10-3.83), bleeding disorders (OR: 1.71, 95 % CI:1.15-2.54), LRYGB versus LSG (OR: 1.63, 95 % CI:1.44-1.85), longer operative time (OR: 1.13, 95 % CI:1.07-1.20), concurrent splenectomy (OR: 4.10, 95 % CI:1.05-16.01), and occurrence of any postoperative complication during index admission (OR: 2.61, 95 % CI:1.99-3.42). Ethnicity, baseline functional status, comorbidities, type and duration of surgical procedure, and postoperative complications occurred in the index admission can predict risk of early readmission following LRYGB and LSG.

  11. Weight loss, weight regain, and conversions to Roux-en-Y gastric bypass: 10-year results of laparoscopic sleeve gastrectomy.

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    Felsenreich, Daniel M; Langer, Felix B; Kefurt, Ronald; Panhofer, Peter; Schermann, Martin; Beckerhinn, Philipp; Sperker, Christoph; Prager, Gerhard

    2016-11-01

    With promising short-term results, laparoscopic sleeve gastrectomy (SG) has become the second most frequently performed bariatric procedure worldwide. Aside from a growing number of reports covering up to 10 years of follow-up, only limited data have been published so far on long-term results. The aim of the study was to present a 10-year follow-up for SG. University hospital setting, Austria. We present the first complete 10-year follow-up of 53 consecutive patients who underwent SG before 2006. In this multicenter study, weight loss success, weight regain, and revisional surgery were analyzed beside Bariatric Analysis and Reporting Outcome System (BAROS) scores. A mean maximum percent excess weight loss of 71±25% (percent total weight loss: 28±15%) was reached at a median of 12 (range 12-120) months after SG. At 10 years, a mean percent excess weight loss of 53±25% was achieved by 32 patients, corresponding to a percent total weight loss of 26.3±13.4%. Nineteen of the 53 patients (36%) were converted to Roux-en-Y gastric bypass (n = 18) or duodenal switch (n = 1) due to significant weight regain (n = 11), reflux (n = 6), or acute revision (n = 2) at a median of 36 months. Two patients died at 3 and 101 months postoperatively, unrelated to SG. A total of 31 patients (59%) suffered from weight regain of 10 kg or more, among them 24 patients (45%) with 15 kg or more, 16 patients (30%) with 20 kg or more, and 7 patients (13%) with 25 kg or more weight regain from nadir. Mean BAROS score was 2.4±2.2 at 10 years follow-up, classifying SG as "fairly efficient." Within a long-term follow-up of 10 years or more after SG, a high incidence of both significant weight regain and intractable reflux was observed, leading to conversion, most commonly to Roux-en-Y gastric bypass. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  12. Laparoscopic revision of Roux-en-Y gastric bypass to sleeve gastrectomy: A ray of hope for failed Roux-en-Y gastric bypass.

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    Lakdawala, Muffazal; Limas, Peter; Dhar, Shilpa; Remedios, Carlyne; Dhulla, Neha; Sood, Amit; Bhasker, Aparna Govil

    2016-05-01

    Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric operation across the world, but sometimes revision is necessary. Inadequate weight loss, weight regain, and complications such as dumping syndrome are common reasons for revision. We report the 1-year outcomes of five patients who underwent laparoscopic conversion of RYGB to sleeve gastrectomy during surgical revision. Mean age was 38.8 ± 9.1 years. Mean BMI at primary surgery was 57.9 ± 8.1 kg/m(2) . Two patients were diabetic and sleep apneic. One was hypertensive. All patients underwent a RYGB as the primary weight loss procedure. Mean weight loss was 36.8 ± 8.6 kg (excess weight loss  = 39.8 ± 14.9%) at 2 years. At the end of 5 years, these patients regained 10.9 ± 4.1 kg (31.5 ± 13.6% of excess weight loss). Primary indications for revision surgery were failure to lose weight, weight regain, and intractable dumping syndrome. Mean duration between primary and revision surgery was 6.2 ± 1.1 years. RYGB was converted to sleeve gastrectomy as a first stage in all cases. Mean duration of revision surgery was 120.0 ± 15.5 min. Mean blood loss was 70 ± 50 mL. One year after revision surgery, a mean weight loss of 21.5 ± 10.5 kg was achieved (mean excess weight loss = 35.8 ± 8.8%). Two patients with type 2 diabetes mellitus and the one with hypertension achieved remission. Dumping was resolved. There were no complications. Laparoscopic conversion of RYGB to sleeve gastrectomy as a first stage may be considered as an additional option in the armamentarium of revision procedures after RYGB. © 2016 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  13. Laparoscopic Conversion of Sleeve Gastrectomy to Gastric Bypass for Super-Obesity (BMI ≥ 50 kg/m²) and Incisional Hernia: a Video Report.

    Science.gov (United States)

    Thereaux, Jérémie; Roche, Charles; Bail, Jean-Pierre

    2016-01-01

    Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed procedure for morbid obesity in France. However, in case of de novo gastroesophageal reflux disease or of insufficient weight loss, LSG could be converted in rare cases to laparoscopic Roux-en-Y gastric bypass (LRYGB). In case of voluminous incisional hernia (IH) associated, this procedure could be technically challenging, especially in cases of super-obesity (body mass index (BMI) ≥50 kg/m2). Furthermore, IH should be repaired in order to avoid life-threatening post-operative small bowel obstruction. We present the case of a 30-year-old woman (125 kg, 1.55 m) with a BMI of 52.1 kg/m2. She was referred to our tertiary care center for weight regain (Nadir 100 kg), 4 years after a LSG was performed for super-super obesity (BMI = 68.7 kg/m2). She also had a history of epigastric IH (single-incision LSG; diameter = 10 cm). The strategy adopted was to repair hernia with raphy. In case of hernia recurrence and of sustainable weight loss, use of prothetic mesh would be mandatory in the future. In this multimedia video, we present a step-by-step laparoscopic conversion of sleeve gastrectomy to LRYGB for super-obesity (BMI ≥50 kg/m2) and incisional hernia. Laparoscopic procedure included adhesiolysis, dissection, and resection of the low part of the remnant stomach, gastro-jejunal circular anastomosis, and closure of aponeurosis defect. Incisional hernia and morbid obesity are often entangled problems. Revisional procedure of bariatric surgery with incisional hernia associated should be performed laparoscopically.

  14. Costs of bariatric surgery in a randomised control trial (RCT) comparing Roux en Y gastric bypass vs sleeve gastrectomy in morbidly obese diabetic patients.

    Science.gov (United States)

    Gounder, Siva T; Wijayanayaka, Delendra Rasith; Murphy, Rinki; Armstrong, Delwyn; Cutfield, Richard G; Kim, David Dw; Clarke, Michael Graham; Evennett, Nicholas J; Humphreys, Martyn Lee; Robinson, Steven John; Booth, Michael Wc

    2016-10-14

    To provide a longitudinal analysis of the direct healthcare costs of providing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery service in the context of a randomised control trial (RCT) of obese patients with type 2 diabetes in Waitemata District Health Board, Auckland, New Zealand. The Waitemata District Health Board costing system was used to calculate costs in New Zealand Dollars (NZD) associated with all pre- and post-operative hospital clinic visits, peri-operative care, hospitalisations and medication costs up to one year after bariatric surgery. Healthcare costs of medications, laboratory investigations and hospital clinic visits for one year prior to enrolment into the RCT were also calculated. One hundred and fourteen patients were randomised to undergo laparoscopic sleeve gastrectomy (LSG, n=58) or laparoscopic Roux en Y gastric bypass (LRYGB, n=56). Total costs one year pre-enrolment was $203,926 for all patients (mean $1,789 per patient). Total cost of surgery was $1,208,005 (mean $9,131 per LSG patient and mean $12,456 per LRYGB patient). Total cost one year post-operatively was $542,656 (mean $4,760 per patient). The total medication cost reduced from $118,993.72(mean $1,044 per patient) to $31,304.93 (mean $274.60 per patient), psurgery than in the year before, although prescription costs were lower post-operatively. There was no significant difference in reduction in prescription cost by surgical procedure at 12 months. However, the LRYGB surgery was more expensive than LSG, primarily because of the longer operative time required.

  15. Comparison of weight loss outcomes 1 year after sleeve gastrectomy and Roux-en-Y gastric bypass in patients aged above 50 years

    Science.gov (United States)

    Praveenraj, Palanivelu; Gomes, Rachel M; Kumar, Saravana; Perumal, Sivalingam; Senthilnathan, Palanisamy; Parthasarathi, Ramakrishnan; Rajapandian, Subbiah; Palanivelu, Chinnusamy

    2016-01-01

    INTRODUCTION: Safe, effective weight loss with resolution of comorbidities has been convincingly demonstrated with bariatric surgery in the aged obese. They, however, lose less weight than younger individuals. It is not known if degree of weight loss is influenced by the choice of bariatric procedure. The aim of this study was to compare the degree of weight loss between laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients above the age of 50 years at 1 year after surgery. MATERIALS AND METHODS: A retrospective analysis was performed of all patients more than 50 years of age who underwent LSG or LRYGB between February 2012 and July 2013 with at least 1 year of follow-up. Data evaluated at 1 year included age, sex, weight, body mass index (BMI), mean operative time, percentage of weight loss and excess weight loss, resolution/remission of diabetes, morbidity and mortality. RESULTS: Of a total of 86 patients, 54 underwent LSG and 32 underwent LRYGB. The mean percentage of excess weight loss at the end of 1 year was 60.19 ± 17.45 % after LSG and 82.76 ± 34.26 % after LRYGB (P = 0.021). One patient developed a sleeve leak after LSG, and 2 developed iron deficiency anaemia after LRYGB. The remission/improvement in diabetes mellitus and biochemistry was similar. CONCLUSION: LRYGB may offer better results than LSG in terms of weight loss in patients over 50 years of age. PMID:27279392

  16. Comparison of weight loss outcomes 1 year after sleeve gastrectomy and Roux-en-Y gastric bypass in patients aged above 50 years

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    Palanivelu Praveenraj

    2016-01-01

    Full Text Available Introduction: Safe, effective weight loss with resolution of comorbidities has been convincingly demonstrated with bariatric surgery in the aged obese. They, however, lose less weight than younger individuals. It is not known if degree of weight loss is influenced by the choice of bariatric procedure. The aim of this study was to compare the degree of weight loss between laparoscopic sleeve gastrectomy (LSG and laparoscopic Roux-en-Y gastric bypass (LRYGB in patients above the age of 50 years at 1 year after surgery. Materials and Methods: A retrospective analysis was performed of all patients more than 50 years of age who underwent LSG or LRYGB between February 2012 and July 2013 with at least 1 year of follow-up. Data evaluated at 1 year included age, sex, weight, body mass index (BMI, mean operative time, percentage of weight loss and excess weight loss, resolution/remission of diabetes, morbidity and mortality. Results: Of a total of 86 patients, 54 underwent LSG and 32 underwent LRYGB. The mean percentage of excess weight loss at the end of 1 year was 60.19 ± 17.45 % after LSG and 82.76 ± 34.26 % after LRYGB (P = 0.021. One patient developed a sleeve leak after LSG, and 2 developed iron deficiency anaemia after LRYGB. The remission/improvement in diabetes mellitus and biochemistry was similar. Conclusion: LRYGB may offer better results than LSG in terms of weight loss in patients over 50 years of age.

  17. Pattern of changes in quality of life of obese patients after sleeve gastrectomy in Sulaimani provence –Kurdistan-Iraq, based on 4 years experience in two bariatric centers

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    Hiwa Omer Ahmed

    2018-02-01

    Full Text Available Background: Obesity influences all aspects of the life of obese patients physically, psychologically, socially and monetarily, it is not only a disease but rather a beginning point of a group of ailments and inabilities, which gradually impacts and changes all aspects of their life. Objectives: The changes in the Quality of life in respect to the amount of access weight lost after sleeve gastrectomy. Patients, materials and methods: A prospective longitudinal study evaluating 40 female patients who underwent laparoscopic sleeve gastrectomy within 4 years, starting from July 4th, 2012 up to July 5th, 2016. Results: More than three-quarter of the patients were not satisfied with their body before their operation, but six to twelve months after their weight loss; (N = 36, 90% of them were satisfied with their new body image. Half of the patients were unhappy before their operation, but twelve months later (N = 31, 77.5% of them became much happier. Regarding satisfaction with the body image, noticeable improvement occurred since (N = 36, 90% of them were satisfied with their new body image. While, most of them have had low self-esteem and (N 27, 67.5% of the patients had no self-esteem at all, 12 months after the operation (N = 35, 87.5% felt great improvement in their self-esteem (p-value = .040. A significant decrease in appetite was noticed in (N = 39, 97.5% of the patients after 12 months. Conclusion: Significant changes in the parallel pattern to the extent of EWL were noticed in the quality of life of morbidly obese patients after laparoscopic sleeve gastrectomy. Keywords: A pattern, Parallel, Reverse-pattern, Laparoscopic sleeve gastrectomy, Quality of life, Non-health quality of life, Morbid obesity

  18. Prospective randomized clinical trial of laparoscopic sleeve gastrectomy versus open Roux-en-Y gastric bypass for the management of patients with morbid obesity.

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    Paluszkiewicz, Rafał; Kalinowski, Piotr; Wróblewski, Tadeusz; Bartoszewicz, Zbigniew; Białobrzeska-Paluszkiewicz, Janina; Ziarkiewicz-Wróblewska, Bogna; Remiszewski, Piotr; Grodzicki, Mariusz; Krawczyk, Marek

    2012-12-01

    Roux-en-Y gastric bypass (RYGB) is considered the gold standard bariatric procedure with documented safety and effectiveness. Laparoscopic sleeve gastrectomy (LSG) is a newer procedure being done with increasing frequency. Randomized comparisons of LSG and other bariatric procedures are limited. We present the results of the first prospective randomized trial comparing LSG and RYGB in the Polish population. To assess the efficacy and safety of LSG versus RYGB in the treatment of morbid obesity and obesity-related comorbidities. Seventy-two morbidly obese patients were randomized to RYGB (36 patients) or LSG (36 patients). Both groups were comparable regarding age, gender, body mass index (BMI) and comorbidities. The follow-up period was at least 12 months. Baseline and 6 and 12 month outcomes were analyzed including assessment of percent excess weight lost (%EWL), reduction in BMI, morbidity (minor, major, early and late complications), mortality, reoperations, comorbidities and nutritional deficiencies. There was no 30-day mortality and no significant difference in major complication rate (0% after RYGB and 8.3% after LSG, p > 0.05) or minor complication rate (16.6% after RYGB and 10.1% after LSG, p > 0.05). There were no early reoperations after RYGB and 2 after LSG (5.5%) (p > 0.05). Weight loss was significant after RYGB and LSG but there was no difference between both groups at 6 and 12 months of follow-up. At 12 months %EWL in RYGB and LSG groups reached 64.2% and 67.6% respectively (p > 0.05). There was no significant difference in the overall prevalence of comorbidities and nutritional deficiencies. Both LSG and RYGB produce significant weight loss at 6 and 12 months after surgery. The procedures are equally effective with regard to %EWL, reduction in BMI and amelioration of comorbidities at 6 and 12 months of follow-up. Laparoscopic sleeve gastrectomy and RYGB are comparably safe techniques with no significant differences in minor and major complication

  19. A COMPARISON OF EFECTIVENESS, AND AN ASSESSMENT OF THE QUALITY OF LIFE OF PATIENTS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY AND ROUX-EN-Y GASTRIC BYPASS.

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    Kaseja, Krzysztof; Majewski, Włodzimierz D; Kołpiewicz, Beata

    2014-01-01

    Morbid obesity is nowadays one of the major problems of well developed countries. Treatment of this disease comprises many modalities, but the most successful are surgical ones. With the advent of laparoscopic operations it became clear that these are particularly useful for operation in obese patients due to their minimal invasiveness. The aim of the study was to compare the effectiveness and quality of life of patients operated on for morbid obesity by laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric by-pass (LRYGB) by one surgeon in one surgical centre. Between 2006-2011 in the Department of General and Vascular Surgery, Szczecin-Zdunowo Specialist Hospital, 74 morbidly obese patients (54 F, 20 M) were operated on by two methods. Mean age (42.4 and 45 years), and body mass index (46.5 ± 8.9 kg/m2 for LSG and 45.1 ± 4.4 kg/m2 for LRYGB) respectively, were comparable. One surgeon in one centre performed LSG in 33 patients (24 F, 9 M) and LRYGB in 41 patients (30 F, 11 M). An independent observer evaluated patients at times of up to 6 months (37 pts), and after 7 months to 36 months (37 pts) postoperatively. Quality of life was assessed by the Gastrointestinal Quality of Life Index (GIQLI) questionnaire, with accessory questions concerning sexual, physical and other activities before and after intervention. There were no serious short or long term complications in either group of patients, although one patient in each group felt permanent postoperative discomfort (2.44% and 3.03%). Percentages of excess weight loss in both groups were similar and reached after 6 months 38.5% for LSG, 39.9% for LRYGB, and after 7-36 months 64.5% for LSG, 66.9% for LRYGB respectively. Quality of life assessment revealed significantly lower values in core symptoms for patients after LRYGB compared to LSG, but after LSG constipation was slightly more frequent. However, the general GIQLI score for patients after both types of surgery was statistically

  20. A 5-Year Follow-Up Study of Laparoscopic Sleeve Gastrectomy Among Morbidly Obese Adolescents: Does It Improve Body Image and Prevent and Treat Diabetes?

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    El-Matbouly, Moamena Ahmed; Khidir, Nesreen; Touny, Hussien Aly; El Ansari, Walid; Al-Kuwari, Mohammed; Bashah, Moataz

    2018-02-01

    Laparoscopic sleeve gastrectomy (LSG) is widely used, and it is important to examine its physiologic and psychological efficacy among adolescents. We assessed LSG's efficacy for weight loss, its short- and long-term effects on resolving and improving obesity-related comorbidities, and its psychological outcomes among morbidly obese adolescents. We retrospectively analyzed the medical records of 91 morbidly obese adolescents in Qatar who underwent LSG (2011-2014), with 1- and 5-year follow-ups. The mean preoperative weight and body mass index (BMI) were 132.5 ± 25.3 kg and 48 ± 7.5 kg/m 2 , respectively. Postoperatively, mean weight and BMI decreased to 101 ± 22 kg and 36.4 ± 7.2 kg/m 2 , respectively. At 1 year, the mean excess weight loss (%EWL), percent total weight loss (%TWL), and percent BMI loss (%BMIL) were 49.48 ± 25.8, 23.1 ± 11.9, and 23.16 ± 11.8%, respectively. At 5 years, %EWL, %TWL, and %BML were 78 ± 12, 35.8 ± 11.5, and 36 ± 12%, respectively. No patients developed postoperative leaks, and three patients had endoscopic dilatation due to stenosis. Overall, 64% of obstructive sleep apnea patients were cured, all prediabetic patients had total remission, and 50% of the diabetic patients were cured. The overall mean HBA1c level was 6 mmol/L, which significantly decreased to 5.1 mmol/L postoperatively (P = 0.0001). At 5 years, there was no relapse of diabetes, and 75% of the diabetic adolescents had complete remission. The only patient with hypertension showed complete resolution with laparoscopic sleeve gastrectomy. Postoperatively, overall body image satisfaction significantly improved (P = 0.0001). LSG significantly ameliorated short- and long-term obesity-related comorbidities and body image dissatisfaction among Qatari adolescents.

  1. Management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity: A tertiary care experience and design of a management algorithm

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    Palanivelu Praveenraj

    2016-01-01

    Full Text Available Background: Laparoscopic sleeve gastrectomy (LSG is the most commonly performed 'standalone' bariatric procedure in India. Staple line gastric leaks occur infrequently but cause significant and prolonged morbidity. The aim of this retrospective study was to analyse the management of patients with a gastric leak after LSG for morbid obesity at our institution. Patients and Methods: From February 2008 to 2014, 650 patients with different degrees of morbid obesity underwent LSG. Among these, all those diagnosed with a gastric leak were included in the study. Patients referred to our institution with gastric leak after LSG were also included. The time of presentation, site of leak, investigations performed, treatment given and time of closure of all leaks were analysed. Results: Among the 650 patients who underwent LSG, 3 (0.46% developed a gastric leak. Two patients were referred after LSG was performed at another institution. The mean age was 45.60 ± 15.43 years. Mean body mass index (BMI was 44.79 ± 5.35. Gastric leak was diagnosed 24 h to 7 months after surgery. One was early, two were intermediate and two were late leaks. Two were type I and three were type II gastric leaks. Endoscopic oesophageal stenting was used variably before or after re-surgery. Re-surgery was performed in all and included stapled fistula excision (re-sleeve, suture repair only or with conversion to roux-en-Y gastric bypass or fistula jujenostomy. There was no mortality. Conclusion: Leakage closure time may be shorter with intervention than expectant management. Sequence and choice of endoscopic oesophageal stenting and/or surgical re-intervention should be individualized according to clinical presentation.

  2. Management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity: A tertiary care experience and design of a management algorithm

    Science.gov (United States)

    Praveenraj, Palanivelu; Gomes, Rachel M; Kumar, Saravana; Senthilnathan, Palanisamy; Parthasarathi, Ramakrishnan; Rajapandian, Subbiah; Palanivelu, Chinnusamy

    2016-01-01

    BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed ‘standalone’ bariatric procedure in India. Staple line gastric leaks occur infrequently but cause significant and prolonged morbidity. The aim of this retrospective study was to analyse the management of patients with a gastric leak after LSG for morbid obesity at our institution. PATIENTS AND METHODS: From February 2008 to 2014, 650 patients with different degrees of morbid obesity underwent LSG. Among these, all those diagnosed with a gastric leak were included in the study. Patients referred to our institution with gastric leak after LSG were also included. The time of presentation, site of leak, investigations performed, treatment given and time of closure of all leaks were analysed. RESULTS: Among the 650 patients who underwent LSG, 3 (0.46%) developed a gastric leak. Two patients were referred after LSG was performed at another institution. The mean age was 45.60 ± 15.43 years. Mean body mass index (BMI) was 44.79 ± 5.35. Gastric leak was diagnosed 24 h to 7 months after surgery. One was early, two were intermediate and two were late leaks. Two were type I and three were type II gastric leaks. Endoscopic oesophageal stenting was used variably before or after re-surgery. Re-surgery was performed in all and included stapled fistula excision (re-sleeve), suture repair only or with conversion to roux-en-Y gastric bypass or fistula jujenostomy. There was no mortality. CONCLUSION: Leakage closure time may be shorter with intervention than expectant management. Sequence and choice of endoscopic oesophageal stenting and/or surgical re-intervention should be individualized according to clinical presentation. PMID:27251808

  3. Perioperative Course, Weight Loss and Resolution of Comorbidities After Primary Sleeve Gastrectomy for Morbid Obesity: Are There Differences Between Adolescents and Adults?

    Science.gov (United States)

    Benedix, Frank; Krause, Thomas; Adolf, Daniela; Wolff, Stefanie; Lippert, Hans; Manger, Thomas; Stroh, Christine

    2017-09-01

    Morbid obesity in both adolescents and adults has risen in an alarming rate. Bariatric surgery is playing an increasing role in pediatric surgery. However, current evidence is limited regarding its safety and outcome. Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered. For the current analysis, all adolescent and adult subjects that had undergone laparoscopic sleeve gastrectomy (LSG) from 2005 to 2014 were considered. LSG represents the most common bariatric procedure in Germany with a proportion of 48.1% in adolescent and 48.7% in adult obese in 2014. LSG was performed in 362 adolescent and 15,428 adult subjects. Pre-operative BMI was comparable between the two populations. However, adult obese had more frequently coexisting comorbidities (p adult group. There was a significantly higher BMI reduction in late adolescents (19-21 years) compared with patients ≤18 years at 24 months (19.8 vs. 13.6 kg/m 2 ). Resolution rate of hypertension was significantly higher in adolescents. LSG is a safe therapeutic option that can be performed in adolescents without mortality. Late adolescents experienced the highest weight loss; resolution rate of comorbidities was lower in adults. All future efforts should now be focused on the evaluation of the long-term outcomes of LSG in the pediatric population.

  4. Effects of Sleeve Gastrectomy vs. Roux-en-Y Gastric Bypass on Eating Behavior and Sweet Taste Perception in Subjects with Obesity.

    Science.gov (United States)

    Nance, Katie; Eagon, J Christopher; Klein, Samuel; Pepino, Marta Yanina

    2017-12-24

    The goal of this study was to test the hypothesis that weight loss induced by Roux-en-Y gastric bypass (RYGB) has greater effects on taste perception and eating behavior than comparable weight loss induced by sleeve gastrectomy (SG). We evaluated the following outcomes in 31 subjects both before and after ~20% weight loss induced by RYGB ( n = 23) or SG ( n = 8): (1) sweet, savory, and salty taste sensitivity; (2) the most preferred concentrations of sucrose and monosodium glutamate; (3) sweetness palatability, by using validated sensory testing techniques; and (4) eating behavior, by using the Food Craving Inventory and the Dutch Eating Behavior Questionnaire. We found that neither RYGB nor SG affected sweetness or saltiness sensitivity. However, weight loss induced by either RYGB or SG caused the same decrease in: (1) frequency of cravings for foods; (2) influence of emotions and external food cues on eating behavior; and (3) shifted sweetness palatability from pleasant to unpleasant when repetitively tasting sucrose (all p -values ≤ 0.01). Therefore, when matched on weight loss, SG and RYGB cause the same beneficial effects on key factors involved in the regulation of eating behavior and hedonic component of taste perception.

  5. Cross-sectional long-term micronutrient deficiencies after sleeve gastrectomy versus Roux-en-Y gastric bypass: a pilot study.

    Science.gov (United States)

    Alexandrou, Andreas; Armeni, Eleni; Kouskouni, Evangelia; Tsoka, Evangelia; Diamantis, Theodoros; Lambrinoudaki, Irene

    2014-01-01

    Nutritional deficiencies are highly prevalent in obese patients. Bariatric surgery has been associated with adverse effects on homeostasis of significant vitamins and micronutrients, mainly after gastric bypass. The aim of the present study was to compare the extent of long-term postsurgical nutritional deficiencies between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). This cross-sectional, pilot study included 95 patients who underwent RYGB or SG surgery with a mean follow-up of 4 years. Demographic, anthropometric, and biochemical parameters were compared according to the type of surgery. Both types of surgery were associated with significant nutritional deficiencies. Vitamin B12 deficiency was significantly higher in patients with RYGB compared with SG (42.1% versus 5%, P = .003). The type of surgery was associated neither with anemia nor with iron or folate deficiency (SG versus RYGB: anemia, 54.2% versus 64.3%, P = .418; folate deficiency, 20% versus 18.4%, P = .884; iron deficiency, 30% versus 36.4%, P = .635). During a mean follow up period of 4 years postRYGB or SG, patients were identified with several micronutrient deficiencies, including vitamin D, folate, and vitamin B12. SG may have a more favorable effect on the metabolism of vitamin B12 compared with RYGB, being associated with less malabsorption. Adherence to supplemental iron and vitamin intake is of primary significance in all cases of bariatric surgery. Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  6. Short- and Midterm Results between Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy for the Treatment of Morbid Obesity

    Directory of Open Access Journals (Sweden)

    Bandar Albeladi

    2013-01-01

    Full Text Available Background. Laparoscopic Roux-en-Y gastric bypass (LRYGB is one of the most widely used bariatric procedures today, and laparoscopic sleeve gastrectomy (LSG as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular in Europe. The aim of this study was to compare short- and midterm results between LRYGB and LSG. Methods. An observational retrospective study from a database of patients undergoing LRYGB and LSG between January 2008 and June 2011. Seventy patients (mean age 39 years were included. Patients were followed at 6, 12, and 18 months. Operative time, length of stay, weight loss, comorbidity improvement or resolution, postoperative complications, reinterventions and mortality were evaluated. Results. Thirty-six LRYGB and 34 LSG were included. Mean operative time of LSG was 106 min while LRYGB was 196 min (. Differences in length of stay, early and late complications, and improvement or resolution in comorbidities were not significant (. Eighteen months after surgery, average excess weight loss was 77.6% in LRYGB and 57.1% in LSG (. There was no surgery-related mortality. Conclusions. Both LRYGB and LSG are safe procedures that provide good results in weight loss and resolution of comorbidities at 18 months.

  7. Effect of Laparoscopic Sleeve Gastrectomy on Fasting Gastrointestinal, Pancreatic, and Adipose-Derived Hormones and on Non-Esterified Fatty Acids.

    Science.gov (United States)

    Farey, John E; Preda, Tamara C; Fisher, Oliver M; Levert-Mignon, Angelique J; Stewart, Rebecca L; Karsten, Elisabeth; Herbert, Benjamin R; Swarbrick, Michael M; Lord, Reginald V

    2017-02-01

    Alterations in gastrointestinal, pancreatic, and adipose hormone levels may have a greater role in weight loss than initially appreciated. The laparoscopic sleeve gastrectomy (LSG) operation is now the most frequently performed bariatric operation in many countries, but there are relatively few data regarding its molecular effects. We sought to characterize the effect of LSG on fasting plasma levels of selected hormones and on non-esterified fatty acids (NEFA), and to compare these to levels in non-obese control individuals. The levels of nine plasma hormones were measured using a multiplex bead-based assay at baseline and at 3 months after operation in 11 obese patients undergoing LSG. NEFA levels were also measured. The levels were compared to those for 22 age- and sex-matched non-obese individuals. At baseline, obese patients showed significantly higher expression of C-peptide, insulin, and leptin and significantly lower ghrelin, glucose-dependent insulinotropic peptide (GIP), and resistin compared to non-obese controls (p fasting levels of factors thought to be important regulators of obesity and metabolic health. These changes differ somewhat from the findings for operations with a malabsorptive component, suggesting that subtle differences exist in the mechanisms of weight loss between LSG and other bariatric operations.

  8. Improvement in cardiovascular risk in women after bariatric surgery as measured by carotid intima-media thickness: comparison of sleeve gastrectomy versus gastric bypass.

    Science.gov (United States)

    Gómez-Martin, Jesús M; Aracil, Enrique; Galindo, Julio; Escobar-Morreale, Héctor F; Balsa, José A; Botella-Carretero, José I

    2017-05-01

    Bariatric surgery may diminish cardiovascular risk (CVR) and its associated mortality. However, studies that compare these effects with different techniques are scarce. To evaluate the changes in CVR as estimated by carotid intima-media thickness (IMT) after obesity surgery in women with high CVR as defined by the presence of metabolic syndrome. Academic hospital. We studied 40 severely obese women, of whom 20 received laparoscopic Roux en Y gastric bypass (RYGB) and 20 received sleeve gastrectomy (SG). Twenty control women matched for age and cardiovascular risk were also included. Patients and controls were evaluated at baseline and 1 year after surgery or conventional treatment with diet and exercise, respectively. Only 18 of the 20 women in the control group were available for analysis after 1 year. None of the women who had bariatric surgery was lost to follow-up. Mean carotid IMT decreased 1 year after surgery irrespective of the surgical technique used, whereas no changes were observed in the control women who had conventional therapy (Wilks´ λ = .802, P = .002 for the interaction, P = .011 for RYGB versus controls, P = .002 for SG versus controls, P = .349 for RYGB versus SG). Both RYGB and SG decrease CVR as measured by carotid IMT in obese women. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  9. Circulating adiponectin increases in obese women after sleeve gastrectomy or gastric bypass driving beneficial metabolic changes but with no relationship with carotid intima-media thickness.

    Science.gov (United States)

    Gómez-Martin, Jesús M; Balsa, José A; Aracil, Enrique; Insenser, María; Priego, Pablo; Escobar-Morreale, Héctor F; Botella-Carretero, José I

    2017-10-12

    Obesity surgery induces beneficial effects in metabolic and cardiovascular parameters. Adiponectin increase might be associated with some of these changes. However, direct comparison between different surgical techniques has not been extensively performed. We studied 20 obese women submitted to laparoscopic Roux en Y gastric bypass (RYGB) and 20 to sleeve gastrectomy (SG). Twenty control women matched for age and baseline metabolic profiles were also included. Both patients and controls were followed up for one year after surgery or conventional treatment with diet and exercise, respectively. Serum adiponectin was measured at baseline, 6 months and 1 year after, as well as lipid profiles, sex hormone binding globulin (SHBG), fasting glucose and insulin. Carotid intima-media thickness was measured by ultrasonography at baseline and after 1 year. Circulating adiponectin increased after obesity surgery (more markedly following RYGB than after SG), whereas no changes were observed in the controls (Wilks' λ = 0.659, P media thickness (r = -0.055, P = 0.679). RYGB induces a higher increase in adiponectin than SG, which parallels SHBG, the reduction of fasting insulin and insulin resistance. On the other hand, no association was found with carotid intima-media, lipid profiles or blood pressure. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  10. Prevalence of Cholelithiasis and Choledocholithiasis in Morbidly Obese South Indian Patients and the Further Development of Biliary Calculus Disease After Sleeve Gastrectomy, Gastric Bypass and Mini Gastric Bypass.

    Science.gov (United States)

    Mishra, Tapas; Lakshmi, Kona Kumari; Peddi, Kiran Kumar

    2016-10-01

    Evaluation of the prevalance of cholelithiasis, choledocholithiasis and there management after sleeve gastrectomy, gastric bypass and mini gastric bypass in Indian bariatric patients. We did a retrospective analysis of our bariatric patient from January 2007 to December 2013 (n = 1397), for prevalence of cholelithiasis and choledocholithiasis. We did synchronous cholecystectomy in all patients planned for bariatric surgery found to have cholelithiasis on USG. Post-operatively, we followed all the patients with gallbladder in situ for minimum of 18-88 months (mean -32.4) and reviewed data for subsequent development of cholelithiasis/choledocholithiasis. Only those patients who were symptomatic underwent intervention. Prevalence of cholelithiasis and choledocholithiasis in our study was 21.76 and 9.63 %, respectively. The incidence of post-bariatric surgery development of cholelithiasis was 10.53 %; individually, it was 8.42 % in LSG group, 13.4 % in LRYGB group and 12.7 % in MGB patients. The incidence of symptomatic cholelithiasis requiring surgery was 1.94 % after LSG, 4.54 % after LRYGB and 4.25 % after MGB. Post-surgery, six patients developed choledocholithiasis. In our post-bariatric group, the 33 patients who developed symptomatic stones had percentage total weight loss of 30.99 + 4.1 (P choledocholithiasis is comparable to that of general population.

  11. Effects of Sleeve Gastrectomy and Gastric Bypass on Postprandial Lipid Profile in Obese Type 2 Diabetic Patients: a 2-Year Follow-up.

    Science.gov (United States)

    Griffo, E; Cotugno, M; Nosso, G; Saldalamacchia, G; Mangione, A; Angrisani, L; Rivellese, A A; Capaldo, B

    2016-06-01

    Bariatric surgery (BS) is known to favorably impact fasting lipid profile. Fasting and postprandial lipids were evaluated before and 2 years after BS in obese type 2 diabetic (T2DM) patients. A prospective study was conducted in 19 obese T2DM patients: ten undergoing sleeve gastrectomy (SG) and nine undergoing Roux-en-Y gastric bypass (RYGB). Before and 2 years after BS, clinical parameters and the response of lipid and incretin hormones to a mixed meal (MM) were assessed. The two groups had similar characteristics at baseline. After BS, weight loss was similar in the two groups (p ≤ 0.01). Fasting glucose, insulin, and triglycerides decreased while HDL cholesterol increased in a similar way (p Postprandial triglycerides decreased after both procedures (p postprandial LDL cholesterol decreased only after RYGB (p postprandial triglycerides and increase HDL cholesterol levels. LDL cholesterol decreases only after RYGB through a mechanism likely mediated by the restoration of GLP-1.

  12. Liver Function in Patients With Nonalcoholic Fatty Liver Disease Randomized to Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy: A Secondary Analysis of a Randomized Clinical Trial.

    Science.gov (United States)

    Kalinowski, Piotr; Paluszkiewicz, Rafał; Ziarkiewicz-Wróblewska, Bogna; Wróblewski, Tadeusz; Remiszewski, Piotr; Grodzicki, Mariusz; Krawczyk, Marek

    2017-11-01

    The aim of the study was to compare the influence of sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB) on liver function in bariatric patients with non-alcoholic fatty liver disease (NAFLD) in a randomized clinical trial (NCT01806506). Rapid weight loss and malabsorption after bariatric surgery in patients with NAFLD or steatohepatitis (NASH) may impair liver function. Sixty-six morbidly obese patients randomized to SG or RYGB were included in a secondary outcome analysis. Intraoperative liver biopsies were categorized with NAFLD Activity Score (NAS) and liver function tests were done before surgery and after 1, 6 and 12 months. NASH was present in 54.5% RYGB and 51.5% SG patients (P > 0.05). At 12 months excess weight loss was 68.7 ± 19.7% after SG and 62.8 ± 18.5% after RYGB (P > 0.05). At 1 month international normalized ratio (INR) increased after RYGB (0.98 ± 0.05 vs 1.14 ± 0.11; P liver function than after SG.

  13. Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis.

    Science.gov (United States)

    Zellmer, Jonathan D; Mathiason, Michelle A; Kallies, Kara J; Kothari, Shanu N

    2014-12-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the current "gold standard" bariatric procedure in the United States. Laparoscopic sleeve gastrectomy (LSG) has recently become a commonly performed procedure for many reasons, including patients' perception that LSG has less complexity and invasiveness, and lower risk. Our objective was to review the literature and compare the leak rates, morbidity, and mortality for LRYGB versus LSG. Publications from 2002 to 2012 with n greater than or equal to 25 and postoperative leak rate reported were included. Statistical analysis included chi-square according to patient number. Twenty-eight (10,906 patients) LRYGB and 33 (4,816 patients) LSG articles were evaluated. Leak rates after LRYGB versus LSG were 1.9% (n = 206) versus 2.3% (n = 110), respectively (P = .077). Mortality rates were .4% (27/7,117) for LRYGB and .2% (7/3,594) for LSG (P = .110). Timing from surgery to leak ranged from 1 to 12 days for LRYGB versus 1 to 35 days for LSG. Leak and mortality rates after LRYGB and LSG were comparable. The appropriate procedure should be tailored based on patient factors, comorbidities, patient and surgeon comfort level, surgeon experience, and institutional outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass lead to equal changes in body composition and energy metabolism 17 months postoperatively: a prospective randomized trial.

    Science.gov (United States)

    Schneider, Julia; Peterli, Ralph; Gass, Markus; Slawik, Marc; Peters, Thomas; Wölnerhanssen, Bettina K

    2016-01-01

    Weight loss is the sum of fat and lean mass loss. The aim of this study was to examine whether there are differences between 2 surgical procedures, laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB), in terms of their effect on body composition and energy metabolism. In addition, the predictive value of preoperative body composition and energy metabolism on postoperative outcome was evaluated. All procedures were performed by the same surgeon (RP) at the St. Claraspital Basel in Switzerland. Calorimetry and DEXA were carried out at the same institution (Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Claraspital Basel). Forty-two morbidly obese, mainly female (85%), nondiabetic and diabetic (50%) patients (body mass index [BMI]: 43.9 kg/m(2)±1.3) before and 17±5.6 months after LSG (n = 23) and LRYGB (n = 19) were examined. Body composition was analyzed by dual-energy X-ray absorptiometry (DEXA) and resting energy expenditure (REE); fat and carbohydrate oxidation was determined by indirect calorimetry. Follow-up was 100%. Excessive BMI loss (EBMIL) was 64.4% in the LSG group and 76.4% in the LRYGB group (PSurgery. Published by Elsevier Inc. All rights reserved.

  15. Laparoscopic gastric bypass versus laparoscopic sleeve gastrectomy: A retrospective multicenter comparison between early and long-term post-operative outcomes.

    Science.gov (United States)

    Rondelli, Fabio; Bugiantella, Walter; Vedovati, Maria Cristina; Mariani, Enrico; Balzarotti Canger, Ruben Carlo; Federici, Sara; Guerra, Adriano; Boni, Marcello

    2017-01-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly performed procedures for morbid obesity. We performed a retrospective review of patients undergoing LRYGB or LSG between August 2000 and November 2014. Data from 581 (280 LSG and 301 LRYGB) were gathered. Operating time (77.6 vs 250.5 min; p < 0.001), post-operative complication rate (3.9% vs 11.6%; p < 0.001), overall occlusions (p = 0.004), need for re-intervention (p < 0.001), hospital stay (5.7 vs 9.2 days; p < 0.001) and mean 1-year EWL (49% vs 61%; p = 0.001) resulted statistically significant lower in LSGs compared with LRYGBs. Not statistically significant differences were found about leakage, bleeding requiring transfusion, infections, short-term mortality and mean 2- and 3-years EWL. Upon univariate analysis, basal weight, basal BMI, age and gender were not associated with the rate of re-intervention and with the combination of re-intervention or death. LRYGB resulted associated with higher post-operative morbidity rate and increased 1-year EWL than LSG. Prospective studies are needed to assess the impact of these two surgical procedures on the long-term weigh loss. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  16. A meta-analysis of 2-year effect after surgery: laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity and diabetes mellitus.

    Science.gov (United States)

    Zhang, Chengda; Yuan, Yuan; Qiu, Cuiqiong; Zhang, Weidong

    2014-09-01

    Literature search was performed for bariatric surgery from inception to September 2013, in which the effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) on body mass index (BMI), percentage of excess weight loss (EWL%), and diabetes mellitus (DM) were compared 2 years post-surgery. A total of 9,756 cases of bariatric surgery from 16 studies were analyzed. Patients receiving LRYGB had significantly lower BMI and higher EWL% compared with those receiving LSG (BMI mean difference (MD) = -1.38, 95% confidence interval (CI) = -1.72 to -1.03; EWL% MD = 5.06, 95% CI = 0.24 to 9.89). Improvement rate of DM was of no difference between the two types of bariatric surgeries (RR = 1.05, 95% CI = 0.90 to 1.23). LRYGB had better long-term effect on body weight, while both LRYGB and LSG showed similar effects on DM.

  17. Short- and Midterm Results between Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy for the Treatment of Morbid Obesity

    Science.gov (United States)

    Albeladi, Bandar; Bourbao-Tournois, Céline; Huten, Noel

    2013-01-01

    Background. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures today, and laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular in Europe. The aim of this study was to compare short- and midterm results between LRYGB and LSG. Methods. An observational retrospective study from a database of patients undergoing LRYGB and LSG between January 2008 and June 2011. Seventy patients (mean age 39 years) were included. Patients were followed at 6, 12, and 18 months. Operative time, length of stay, weight loss, comorbidity improvement or resolution, postoperative complications, reinterventions and mortality were evaluated. Results. Thirty-six LRYGB and 34 LSG were included. Mean operative time of LSG was 106 min while LRYGB was 196 min (P 0.05). Eighteen months after surgery, average excess weight loss was 77.6% in LRYGB and 57.1% in LSG (P = 0.003). There was no surgery-related mortality. Conclusions. Both LRYGB and LSG are safe procedures that provide good results in weight loss and resolution of comorbidities at 18 months. PMID:24078867

  18. Impact of preoperative wait time due to insurance-mandated medically supervised diets on weight loss after sleeve gastrectomy. Are patients losing momentum?

    Science.gov (United States)

    Ying, Lee D; Duffy, Andrew J; Roberts, Kurt E; Ghiassi, Saber; Hubbard, Matthew O; Nadzam, Geoffrey S

    2017-09-01

    Few studies have examined whether preoperative period length, as defined by the amount of time from enrollment in a surgical weight loss program to the day of surgery, affects postoperative weight loss. To identify associations between preoperative period length and postoperative weight loss. Single surgeon at an academic medical center in the United States. Retrospective chart review in 109 consecutive patients undergoing sleeve gastrectomy from 2014-2015. When patients were grouped based on postoperative percentage of total weight loss, greater weight loss was associated with shorter preoperative wait time. During the preoperative period, 72.2% of our patients achieved a net weight loss, but 34.6% had gained net weight until they started the preoperative "liver-shrinking" diet; 71.4±8.3% of the total preoperative weight loss occurred after initiating the preoperative diet, which accounted for approximately 15% of the whole preoperative period length. There was no correlation between the length of the preoperative diet and preoperative weight loss. Shorter preoperative periods and earlier initiation of liver reduction diets may increase postoperative weight loss, although ultimately there may be a limit to the weight loss that patients can achieve while adhering to highly restrictive lifestyle modifications. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  19. Ghrelin, leptin, and glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass-results of a randomized clinical trial.

    Science.gov (United States)

    Kalinowski, Piotr; Paluszkiewicz, Rafał; Wróblewski, Tadeusz; Remiszewski, Piotr; Grodzicki, Mariusz; Bartoszewicz, Zbigniew; Krawczyk, Marek

    2017-02-01

    Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) cause weight loss and metabolic improvement, but results of published studies are contradictory. The aim of this study was to compare the effects of SG and RYGB on ghrelin, leptin, and glucose homeostasis in a randomized controlled trial. University hospital, Poland. Seventy-two morbidly obese patients were randomly selected to undergo either SG (n = 36) or RYGB (n = 36). Fasting ghrelin, leptin, glucose, insulin, C-peptide, glucagon, glycated hemoglobin, and homeostasis model assessment of insulin resistance were assessed preoperatively and at 1, 6, and 12 months postoperatively. No differences were found in anthropometric and biochemical parameters between the study groups at baseline. Sixty-nine (95.8%) patients completed the study. Percentage of excess weight loss at 12 months was 67.6±19.3% after SG and 64.2±18.5% after RYGB (P>.05). Fasting ghrelin levels decreased 1 month after SG (from 76.8 pmol/L to 35.3 pmol/L; PGhrelin levels decrease after SG and increase after RYGB, but this difference does not affect similar outcomes of these procedures during 1-year follow-up. The contribution of ghrelin to weight loss or metabolic benefits after bariatric surgery is not straightforward, but rather influenced by multiple factors. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  20. Effects of Sleeve Gastrectomy vs. Roux-en-Y Gastric Bypass on Eating Behavior and Sweet Taste Perception in Subjects with Obesity

    Directory of Open Access Journals (Sweden)

    Katie Nance

    2017-12-01

    Full Text Available The goal of this study was to test the hypothesis that weight loss induced by Roux-en-Y gastric bypass (RYGB has greater effects on taste perception and eating behavior than comparable weight loss induced by sleeve gastrectomy (SG. We evaluated the following outcomes in 31 subjects both before and after ~20% weight loss induced by RYGB (n = 23 or SG (n = 8: (1 sweet, savory, and salty taste sensitivity; (2 the most preferred concentrations of sucrose and monosodium glutamate; (3 sweetness palatability, by using validated sensory testing techniques; and (4 eating behavior, by using the Food Craving Inventory and the Dutch Eating Behavior Questionnaire. We found that neither RYGB nor SG affected sweetness or saltiness sensitivity. However, weight loss induced by either RYGB or SG caused the same decrease in: (1 frequency of cravings for foods; (2 influence of emotions and external food cues on eating behavior; and (3 shifted sweetness palatability from pleasant to unpleasant when repetitively tasting sucrose (all p-values ≤ 0.01. Therefore, when matched on weight loss, SG and RYGB cause the same beneficial effects on key factors involved in the regulation of eating behavior and hedonic component of taste perception.

  1. To Sleeve or NOT to Sleeve in Bariatric Surgery?

    OpenAIRE

    van Rutte, P. W. J.; Luyer, M. D. P.; de Hingh, I. H. J. T.; Nienhuijs, S. W.

    2012-01-01

    Morbid obesity has become a global epidemic during the 20th century. Until now bariatric surgery is the only effective treatment for this disease leading to sustained weight loss and improvement of comorbidities. The sleeve gastrectomy is becoming a promising alternative for the gold standard the gastric bypass and it is gaining popularity as a stand-alone procedure. The effect of the laparoscopic sleeve gastrectomy is based on a restrictive mechanism, but a hormonal effect also seems to play...

  2. Effect of Bariatric Sleeve Gastrectomy Technique on Women’s Lower Urinary Tract Symptoms and Quality of Life: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Fatih Uruç

    2016-09-01

    Full Text Available Objective Obesity triggers lower urinary tract symptoms (LUTS secondary to accumulation of excess fat which may lead to increase in intra-abdominal/intravesical pressures and subsequent impairment in pelvic floor muscles. However, it is considered that weight loss resolve these symptoms. In this study, we aimed to investigate the effects of bariatric surgery and especially Sleeve gastrectomy (SG on women’s LUTS, and quality of life. Materials and Methods A total of 53 patients who have undergone laparoscopic SG in our clinics between April 2014 and March 2015 were included in this prospective study. Age, body weight and body mass index (BMI of the participants were preoperatively and postoperatively recorded. The patients have pre/post-operatively filled the Beck depression inventory (BDI, International prostate symptom score (IPSS, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF and the 36-Item Short Form health survey (SF-36 scores were recorded. Additionally, post-operative decrease in body weight and BMI of the patients was recorded. Results There was a statistically significant decrease in mean BDI, IPSS and ICIQ-SF scores and SF-36 (prominent increment in physical and mental component summary (PCS and MCS scores, when compared with pre-operative values. A positive correlation was found between BMI and parameters including age, BDI and IPSS. However, no significant correlation was present between BMI and the parameters including ICIQ-SF, PCS and MCS. Conclusion Negative effect of obesity on LUTS and quality of life cannot be ignored. We assume that bariatric surgery can induce dramatic weight loss, amelioration in symptoms of urinary dysfunction and increase in quality of life of women.

  3. Effects of sleeve gastrectomy and ileal transposition, alone and in combination, on food intake, body weight, gut hormones, and glucose metabolism in rats.

    Science.gov (United States)

    Nausheen, S; Shah, I H; Pezeshki, A; Sigalet, D L; Chelikani, P K

    2013-08-15

    Bariatric surgeries are hypothesized to produce weight loss and improve diabetes control by multiple mechanisms including gastric restriction and lower gut stimulation; the relative importance of these mechanisms remains poorly understood. We compared the effects of a typical foregut procedure, sleeve gastrectomy, (SG) with a primarily hindgut surgery, ileal transposition (IT), alone and together (SGIT), or sham manipulations, on food intake, body weight, gut hormones, glucose tolerance, and key markers of glucose homeostasis in peripheral tissues of adult male Sprague-Dawley rats (450-550 g, n = 7-9/group). SG, IT, and SGIT surgeries produced transient reduction in food intake and weight gain; the effects of SG and IT on intake and body weight were nonadditive. SG, IT, and SGIT surgeries resulted in increased tissue expression and plasma concentrations of the lower gut hormones glucagon-like peptide-1 and peptide YY and decreased plasma glucose-dependent insulinotropic peptide, insulin, and leptin concentrations. Despite transient effects on intake and weight gain, the SG, IT, and SGIT surgeries produced a significant improvement in glucose tolerance. In support of glycemic improvements, the protein abundance of key markers of glucose metabolism (e.g., GLUT4, PKA, IRS-1) in muscle and adipose tissue were increased, whereas the expression of key gluconeogenic enzyme in liver (G-6-Pase) were decreased following the surgeries. Therefore, our data suggest that enhanced lower gut stimulation following SG, IT, and SGIT surgeries leads to transient reduction in food intake and weight gain together with enhanced secretion of lower gut hormones and improved glucose clearance by peripheral tissues.

  4. Gut microbiota after Roux-en-Y gastric bypass and sleeve gastrectomy in a diabetic rat model: Increased diversity and associations of discriminant genera with metabolic changes.

    Science.gov (United States)

    Guo, Yan; Liu, Chao-Qian; Shan, Cheng-Xiang; Chen, Yue; Li, Hui-Hua; Huang, Zhi-Ping; Zou, Da-Jin

    2017-03-01

    Recent work with gut microbiota after bariatric surgery is limited, and the results have not been in agreement. Given the role of the gut microbiota in regulating host metabolism, we explored the effect of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on the modifications of gut microbiota with regard to the potential influence of food intake and/or weight loss and examined their links with host metabolism. Zucker diabetic fatty rats were divided into the following groups: RYGB; sham-operated with pair-fed as RYGB; sham-operated fed ad libitum; and SG. The metabolic effects and gut microbiota profile were analyzed 10 weeks postoperatively. Associations between discriminating genera and metabolic markers after RYGB were explored. The 2 procedures induced similar glucose improvement and increased flora diversity after 10 weeks compared with sham-operated groups. RYGB induced a marked higher relative abundance of Proteobacteria/Gammaproteobacteria and Betaproteobacteria and increased emergence of Fusobacteria and Clostridium, whereas SG resulted in more abundant Actinobacteria compared with other groups. Most of the 12 discriminant genera correlated with changes in metabolic phenotype, but only 28.6% of these correlations were independent of weight, and 4 discriminant genera still negatively correlated with serum insulin level independent of food intake and weight loss after RYGB. These data demonstrate that RYGB and SG surgery produced similar diversity but different microbiota compositions changes in Zucker diabetic fatty rats. These findings stimulate deeper explorations of functions of the discriminate microbiota and the mechanisms linking postsurgical modulation of gut microbiota and improvements in insulin resistance. Copyright © 2016 John Wiley & Sons, Ltd.

  5. Changes in Fasting and Prandial Gut and Adiposity Hormones Following Vertical Sleeve Gastrectomy or Roux-en-Y-Gastric Bypass: an 18-Month Prospective Study.

    Science.gov (United States)

    Alamuddin, Naji; Vetter, Marion L; Ahima, Rexford S; Hesson, Louise; Ritter, Scott; Minnick, Alyssa; Faulconbridge, Lucy F; Allison, Kelly C; Sarwer, David B; Chittams, Jesse; Williams, Noel N; Hayes, Matthew R; Loughead, James W; Gur, Ruben; Wadden, Thomas A

    2017-06-01

    Vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) produce substantial weight loss, both primarily through gastric restriction but with potentially different hormonal signaling. This prospective, observational study compared changes in gut-derived hormones in VSG, RYGB, and weight-stable participants at 6 and 18 months post-surgery. Sixty-four obese, non-diabetic women, including 18 VSG, 23 RYGB, and 23 weight-stable controls completed assessments at baseline and 6 months, before and after consuming a mixed-nutrient meal; blood sampling occurred for 180 min post-meal. Fifty-one participants completed the 18-month outcome. Change from baseline in post-prandial area under the curve (over 180 min) for GLP-1, PYY 3-36 , ghrelin, and leptin was measured at 6 and 18 months post-surgery. At 18 months, VSG and RYGB participants lost a mean (±SEM) of 25.5 ± 2.3% and 34.2 ± 4.2% of initial weight, respectively (p Fasting ghrelin declined significantly more in VSG than RYGB participants at both months 6 (p = 0.0199) and 18 (p = 0.0003). In response to the mixed-nutrient meal, GLP-1 and PYY 3-36 demonstrated an exaggerated post-prandial response that was significantly greater in RYGB than VSG at 6 months (p gastrointestinal hormones as mediators of weight loss.

  6. Effects of obesity surgery (laparoscopic sleeve gastrectomy technique) on lower urinary tract symptoms, depression and quality of life of males: Prospective study.

    Science.gov (United States)

    Uruç, Fatih; Akan, Serkan; Aras, Bekir; Yıldırım, Çaglar; Sahin, Aytaç; Yuksel, Ozgur Haki; Aydın, Mehmet Timuçin; Verit, Ayhan

    2016-12-30

    Technically, obesity weakens the pelvic base muscles by causing an increase in the intraabdominal pressure and intravesical pressure due to increasing fat and it triggers the occurrence of lower urinary tract symptoms. However it is believed that weight loss will cause recovery of these symptoms. Our purpose in this study is to research about the effects of the weight loss achieved by using especially the Laparoscopic Sleeve Gastrectomy (LSG) technique of bariatric surgery which is being more and more widely used today. Out of all patients who had LSG surgery due to obesity earlier in our center during the period between April 2014 and March 2015, 22 applicable male patients were considered after a brief exclusion criteria application. Age, height, weight, and body mass index (BMI) data of these patients were recorded before the operation. International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire - short from) (ICIQ-SF), Beck depression inventory (BECK) and Short form - 36 (SF-36) were filled for the patients and the data were recorded. Also, the weight loss amounts and BMI decreases of the patients after the operation were recorded. After the procedure, the decrease in the averages of BECK depression inventory, IPSS, ICIQ-SF and the increase in the Mental and Physical subgroup scores of SF-36 were found statistically coherent. The adverse effect of obesity, which is observed more and more often in today's world, on lower urinary tract symptoms and on the quality of life is undeniable. In our study, we think that the bariatric surgery made by using the LSG technique, not only causes serious amount of weight loss, but also reduces urinary dysfunction and enhances the quality of life among males.

  7. Sleeve gastrectomy with jejunal bypass for the treatment of type 2 diabetes mellitus in patients with body mass index <35 kg/m2. A cohort study.

    Science.gov (United States)

    Alamo, Munir; Sepúlveda, Matías; Gellona, José; Herrera, Mauricio; Astorga, Cristián; Manterola, Carlos

    2012-07-01

    The objective of this study was to evaluate sleeve gastrectomy with jejunal bypass (SGJB) as a surgical treatment for type 2 diabetes mellitus (T2DM) in patients with a body mass index (BMI) Chile were included. SGJB consists of creating a gastric tube, which preserves the pylorus, and performing a jejunoileal anastomosis 300 cm distal to the angle of Treitz. Excess weight loss (EWL) and complete or partial remission of T2DM were reported. Forty-nine patients met the inclusion criteria. The mean age was 49 years (36-62), and 53 % of patients were female. Mean preoperative BMI was 31.6 kg/m(2) (25-34.9 kg/m(2)). Operation time was 123 ± 14 min, with 94.7 % of operations performed laparoscopically. Mean postoperative hospital stay was 2 days. Mean postoperative follow-up was 12 months. Median EWL at 1, 3, 6, 12, and 18 months postoperatively was 31.9 %, 56.9 %, 76.1 %, 81.5 %, and 76.1 %, respectively. Complete T2DM remission was achieved in 81.6 % of patients (40/49) and partial remission in 18.4 % (9/49). Forty of 41 patients (97.6 %) on oral hypoglycemic agents achieved complete T2DM remission, and 100 % of insulin-dependent patients stopped using insulin but were still being treated for T2DM. One patient experienced postoperative gastrointestinal bleeding. There were no deaths. SGJB is an effective treatment for T2DM in patients with BMI <35 kg/m(2).

  8. Bariatric surgery in old age: a comparative study of laparoscopic Roux–en-Y gastric bypass and sleeve gastrectomy in an Asia centre of excellence

    Science.gov (United States)

    Huang, Chih-Kun; Garg, Amit; Kuao, Hsin-Chih; Chang, Po-Chih; Hsin, Ming-Che

    2015-01-01

    Abstract Bariatric surgery has been proved to be the safest and efficient procedure in treating morbid obese patients, but data is still lacking in the elderly population. The aim of our study was to compare the safety and efficacy of laparoscopic Roux–en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) in patients aged more than 55 years. We performed a retrospective review of a prospectively collected database. All patients with body mass index (BMI) ≧32 kg/m2 and aged more than 55 years undergoing LRYGB or LSG in BMI Surgery Centre, E-Da Hospital between January 2008 and December 2011 with at least one year of follow up were included for the analysis. Demography, peri-operative data, weight loss and surgical complications were all recorded and analyzed. Mean age and BMI of these 68 patients (22 males and 46 female) were 58.8 years (55–79 years) and 39.5 kg/m2 (32.00–60.40 kg/m2). LRYGB was performed in 44 patients and LSG in 24 patients. The two groups were comparable in their preoperative BMI, American Society of Anaesthesia (ASA) score and gender distribution. LSG patients were significantly older than patients receiving LRYGB. The proportion of type 2 diabetes preoperatively was significantly higher in LRYGB patients as compared to LSG patients (88.63% vs. 50%; P elderly patients, both surgeries achieved good weight loss and resolution of comorbidities. LRYGB is superior to LSG in terms of diabetes remission but carries higher complication rates even at high volume centres. PMID:25859266

  9. Effects of sleeve gastrectomy and medical treatment for obesity on glucagon-like peptide 1 levels and glucose homeostasis in non-diabetic subjects.

    Science.gov (United States)

    Valderas, Juan Patricio; Irribarra, Veronica; Rubio, Lorena; Boza, Camilo; Escalona, Manuel; Liberona, Yessica; Matamala, Andrea; Maiz, Alberto

    2011-07-01

    The effects of medical and surgical treatments for obesity on glucose metabolism and glucagon-like peptide 1 (GLP-1) levels independent of weight loss remain unclear. This study aims to assess plasma glucose levels, insulin sensitivity and secretion, and GLP-1 levels before and after sleeve gastrectomy (SG) or medical treatment (MED) for obesity. This study is a prospective, controlled, non-randomised study. Two groups of non-diabetic obese patients with similar BMIs, including a SG group (BMI, 35.5 ± 0.9 kg/m(2); n = 6) and a MED group (BMI, 37.7 ± 1.9 kg/m(2); n = 6) and a group of lean subjects (BMI, 21.7 ± 0.7 kg/m(2); n = 8). Plasma glucose, insulin, and total GLP-1 levels at fasting and after the intake of a standard liquid meal at baseline and at 2 months post-intervention. At baseline, total GLP-1 levels were similar, but obese patients had lower insulin sensitivity and higher insulin secretion than lean subjects. At 2 months post-intervention, SG and MED patients achieved similar weight loss (14.4 ± 0.8%, 15.3 ± 0.9%, respectively). Insulin sensitivity increased in SG and MED patients; however, postprandial insulin secretion decreased after MED, but not after SG. The incremental area under the curve of GLP-1 increased after SG (P = 0.04), but not after MED. Weight loss by medical or surgical treatment improved insulin sensitivity. However, only MED corrected the hyperinsulinemic postprandial state associated to obesity. Postprandial GLP-1 levels increased significantly after SG without duodenal exclusion, which may explain why insulin secretion did not decrease following this surgery.

  10. Comparison of results after one year between sleeve gastrectomy and gastric bypass in patients with BMI ≥ 50 kg/m².

    Science.gov (United States)

    Thereaux, Jérémie; Corigliano, Nicola; Poitou, Christine; Oppert, Jean-Michel; Czernichow, Sebastien; Bouillot, Jean-Luc

    2015-01-01

    Although laparoscopic sleeve gastrectomy (LSG) was initially described as the first step of a 2-stage procedure for high-risk patients requiring laparoscopic Roux-en-Y gastric bypass (LRYGB), it is now being used as a single-stage procedure. Experience with laparoscopic bariatric surgery is growing, such that LRYGB is increasingly feasible for patients with body mass index (BMI) ≥ 50 kg/m². Nevertheless, outcomes for such category of patients following LSG and LRYGB are lacking. To compare weight loss and changes in obesity related co-morbidities at one year following LSG with LRYGB in patients with BMI ≥ 50 kg/m². The prospective database of a single surgery university center was queried for clinical and other relevant data. From January 2004 to January 2013, 74 and 285 patients underwent LSG or LRYGB with a BMI ≥ 50 kg/m². At one year, rate of follow-up was 92.8%. Success of surgery was defined as % of excess weight loss (%EWL)≥ 50% at one year. Logistic regression was used to compute odds ratio (OR) to evaluate the success at one year of surgery. LSG (N = 74) and LGBP (N = 285) groups did not differ for initial BMI (57.2 ± 7.1 versus 56.7 ± 5.5 kg/m²; P = .52), % of female (64.6% versus 73.7%, P = .13) or major adverse postoperative events (5.7% versus 6.7%; P = .85). At one year, the mean percentage of weight loss (%) (22.0 ± 7.6 versus 30.3 ± 7.4; P Surgery. Published by Elsevier Inc. All rights reserved.

  11. Diabetes improvement and resolution following laparoscopic vertical sleeve gastrectomy (LVSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures: a systematic review of randomized controlled trials.

    Science.gov (United States)

    Osland, Emma; Yunus, Rossita Mohamad; Khan, Shahjahan; Memon, Breda; Memon, Muhammed Ashraf

    2017-04-01

    The prevalence of type 2 diabetes is growing in both developed and developing countries and is strongly linked with the prevalence of obesity. Bariatric surgical procedures such as laparoscopic vertical sleeve gastrectomy (LVSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are increasingly being utilized to manage related comorbid chronic conditions, including type 2 diabetes. A systematic review of randomized controlled trials (RCTs) was undertaken using the PRISMA guidelines to investigate the postoperative impact on diabetes resolution following LVSG versus LRYGB. Seven RCTs involving a total of 732 patients (LVSG n = 365, LRYGB n = 367) met inclusion criteria. Significant diabetes resolution or improvement was reported with both procedures across all time points. Similarly, measures of glycemic control (HbA1C and fasting blood glucose levels) improved with both procedures, with earlier improvements noted in LRYGB that stabilized and did not differ from LVSG at 12 months postoperatively. Early improvements in measures of insulin resistance in both procedures were also noted in the studies that investigated this. This systematic review of RCTs suggests that both LVSG and LRYGB are effective in resolving or improving preoperative type 2 diabetes in obese patients during the reported 3- to 5-year follow-up periods. However, further studies are required before longer-term outcomes can be elucidated. Areas identified that need to be addressed for future studies on this topic include longer follow-up periods, standardized definitions and time point for reporting, and financial analysis of outcomes obtained between surgical procedures to better inform procedure selection.

  12. Long-term changes in leptin, chemerin and ghrelin levels following different bariatric surgery procedures: Roux-en-Y gastric bypass and sleeve gastrectomy.

    Science.gov (United States)

    Terra, Ximena; Auguet, Teresa; Guiu-Jurado, Esther; Berlanga, Alba; Orellana-Gavaldà, Josep Maria; Hernández, Mercè; Sabench, Fàtima; Porras, Jose Antonio; Llutart, Jordi; Martinez, Salomé; Aguilar, Carmen; Del Castillo, Daniel; Richart, Cristóbal

    2013-11-01

    Different studies have evaluated changes in adipo/cytokine levels after bariatric surgery and have given conflicting results. The adipo/cytokines, leptin and chemerin, and the orexigenic hormone, ghrelin, have been shown to play a role in the regulation of metabolism and appetite. The aims of our study were to test the levels of these molecules after bariatric surgery and to compare the results between Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. We analysed circulating levels of chemerin, ghrelin and leptin in 30 morbidly obese women (body mass index of >40 kg/m2). Subjects were studied at three time points: baseline (before the surgery started), and after 6 and 12 months. After surgery, chemerin (baseline, 95.03 ± 23.79; after 12 months, 76.80 ± 21.51; p = 0.034) and leptin levels (baseline, 248.17 ± 89.16; after 12 months, 63.85 ± 33.48; p surgery in terms of weight reduction, general metabolic state or adipo/cytokine levels after surgery. Our study demonstrates a marked decrease in fasting leptin and chemerin levels, and an increase in ghrelin levels, after bariatric surgery-induced weight loss, independently of the type of surgery performed. Further studies are needed on the interrelation between the changes in the circulating levels of these molecules and the efficacy of the bariatric surgery procedures to induce the beneficial metabolic changes and to sustain body weight loss.

  13. Long-term and midterm outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass: a systematic review and meta-analysis of comparative studies.

    Science.gov (United States)

    Shoar, Saeed; Saber, Alan A

    2017-02-01

    This study aimed to compare midterm and long-term weight loss and resolution of co-morbidity with laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). LRYGB and LSG are the most common procedures performed in bariatric surgery. However, their weight loss efficacy in the midterm and long-term has not been well compared. A meta-analysis was performed by systematically identifying comparative studies conducted until the end of June 2016 that investigated weight loss outcome and resolution of co-morbidities (type 2 diabetes mellitus, hypertension, hyperlipidemia, hypertriglyceridemia, and obstructive sleep apnea) with LRYGB and LSG in the midterm (3-5 years) and long term (≥5 years). The primary endpoint was weight loss after LRYGB versus LSG. The secondary endpoint was resolution of co-morbidities after these procedures. Fourteen studies comprising 5264 patients were eligible. Follow-up ranged from 36 months to 75.8±8.4 months. The pooled result for weight loss outcomes did not show any significant difference in midterm weight loss (standardized mean difference = -0.03; 95% confidence interval (CI), -0.38-.33; P = .88) but a significant difference in the long-term weight loss outcome favoring LRYGB (standardized mean difference = .17; 95% CI, .05-.28; P= .005). The pooled results demonstrated no significant difference for resolution of type 2 diabetes mellitus, hypertension, hyperlipidemia, and hypertriglyceridemia. Despite the insignificant difference between LRYGB and LSG in midterm weight loss, LRYGB produced better weight loss in the long-term. There was no significant difference between the 2 procedures for co-morbidity resolution. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  14. Laparoscopic sleeve gastrectomy conversion to Roux-en-Y gastric bypass: experience in 50 patients after 1 to 3 years of follow-up.

    Science.gov (United States)

    Quezada, Nicolás; Hernández, Julián; Pérez, Gustavo; Gabrielli, Mauricio; Raddatz, Alejandro; Crovari, Fernando

    Sleeve gastrectomy (SG) is currently one of the most frequently performed bariatric interventions worldwide due to its simplicity and good weight loss results. Nevertheless, SG failure and complications are increasingly being observed as the number of procedures increases. To report our results in converting SG to revisional laparoscopic Roux-en-Y gastric bypass (R-LRYGB). University Hospital, Chile. Retrospective analysis of our bariatric surgery database. Patients who underwent R-LRYGB after SG between June 2005 and April 2015 were identified. Demographic characteristics, anthropometrics, preoperative workup, and perioperative data were retrieved. Total weight loss (TWL), excess weight loss (EWL), and clinical progression over 3 years were registered. Fifty patients were identified, mean age 39±8.4 years, 42 (84%) women; median body mass index previous to R-LRYGB was 33.8 (31-36) kg/m 2 . Indications for revision were weight regain (n = 28, 56%), gastroesophageal reflux disease (n = 16, 32%), and gastric stenosis (n = 6, 12%). In weight-regain patients, mean follow-up at 3 years was 72.2% and median percentage of total weight loss at 12 and 36 months was 18.5 (12-24) and 19.3 (8-23), respectively; percentage of excess weight loss at 12 and 36 months was 60.7 (37-82) and 66.9 (26-90), respectively. Over 90% of gastroesophageal reflux disease patients resolved or improved symptoms. All patients with gastric stenosis resolved symptoms after conversion. There were no major complications. R-LRYGB is a feasible, effective, and well-tolerated alternative in selected patients with failed SG in which other therapies have been insufficient to either maintain weight loss or resolve complications. However, long-term follow-up is still needed. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  15. Assessment of perioperative complications following primary bariatric surgery according to the Clavien-Dindo classification: comparison of sleeve gastrectomy and Roux-Y gastric bypass.

    Science.gov (United States)

    Goitein, David; Raziel, Asnat; Szold, Amir; Sakran, Nasser

    2016-01-01

    Laparoscopic Roux-Y gastric bypass (LRYGBP) is the gold-standard procedure for the treatment of morbid obesity. It has been reported to be somewhat more efficient and durable than laparoscopic sleeve gastrectomy (LSG). However, it is considered more invasive and, therefore, more hazardous. There is a lack of unity in complication reporting following bariatric surgery. Thus, there is a possible misconception regarding the relative safety of the two major bariatric procedures performed worldwide. This may have contributed to a shift in practice with LSG gaining momentum "at the expense" of LRYGBP. The aim of this study was to evaluate the relative safety of primary LSG and LRYGBP according to the Clavien-Dindo complication grading system. A total of 2651 and 554 patients underwent primary LSG and LRYGBP, respectively at three high-volume centers. Thirty-day perioperative complications were recorded and graded. Length of hospital stays (LOS) and readmission rates were collected as well. Complications occurred in 110 (3.7%) and 24 (4.3%) patients following LSG and LRYGBP, respectively (p = 0.9). No significant difference was found between the groups regarding overall and complication-grade-specific rates. Individual complication types were unevenly distributed, but not significantly so. Patients with complications were older than those without (47 and 43 years, respectively; p = 0.01). Gender was not a risk factor for complication. Median LOS and readmission rates were not significantly different. LSG and LRYGBP are equally safe, at least in the perioperative period. Acknowledging and conveying this finding to surgeons and patients alike is important and might cause a pendulum shift in the distribution of bariatric procedures performed.

  16. Remodeling of the residual gastric mucosa after roux-en-y gastric bypass or vertical sleeve gastrectomy in diet-induced obese rats.

    Directory of Open Access Journals (Sweden)

    Konstantinos Arapis

    Full Text Available Whereas the remodeling of intestinal mucosa after bariatric surgeries has been the matter of numerous studies to our knowledge, very few reported on the remodeling of the residual gastric mucosa. In this study, we analyzed remodeling of gastric mucosa after Roux-en-Y gastric bypass (RYGB and vertical sleeve gastrectomy (VSG in rats. Diet-induced obese rats were subjected to RYGB, VSG or sham surgical procedures. All animals were assessed for food intake, body-weight, fasting blood, metabolites and hormones profiling, as well as insulin and glucose tolerance tests before and up to 5 weeks post-surgery. Remodeling of gastric tissues was analyzed by routine histology and immunohistochemistry studies, and qRT-PCR analyses of ghrelin and gastrin mRNA levels. In obese rats with impaired glucose tolerance, VSG and RYGB caused substantial weight loss and rats greatly improved their oral glucose tolerance. The remaining gastric mucosa after VSG and gastric pouch (GP after RYGB revealed a hyperplasia of the mucous neck cells that displayed a strong immunoreactivity for parietal cell H+/K+-ATPase. Ghrelin mRNA levels were reduced by 2-fold in remaining fundic mucosa after VSG and 10-fold in GP after RYGB. In the antrum, gastrin mRNA levels were reduced after VSG in line with the reduced number of gastrin positive cells. This study reports novel and important observations dealing with the remaining gastric mucosa after RYGB and VSG. The data demonstrate, for the first time, a hyperplasia of the mucous neck cells, a transit cell population of the stomach bearing differentiating capacities into zymogenic and peptic cells.

  17. Improvements in hippocampal-dependent memory and microglial infiltration with calorie restriction and gastric bypass surgery, but not with vertical sleeve gastrectomy.

    Science.gov (United States)

    Grayson, B E; Fitzgerald, M F; Hakala-Finch, A P; Ferris, V M; Begg, D P; Tong, J; Woods, S C; Seeley, R J; Davidson, T L; Benoit, S C

    2014-03-01

    Much recent evidence suggest that obesity and related comorbidities contribute to cognitive decline, including the development of non age-related dementia and Alzheimer's disease. Obesity is a serious threat to public health, and few treatments offer proven long-term weight loss. In fact, bariatric surgery remains the most effective long-term therapy to reduce weight and alleviate other aspects of the metabolic syndrome (MetS). Unlike the demonstrated benefits of caloric restriction to prevent weight gain, few if any studies have compared various means of weight loss on central nervous system function and hippocampal-dependent cognitive processes. Our studies comprise the first direct comparisons of caloric restriction to two bariatric surgeries (Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG)) on cognitive function. Weight loss following caloric restriction, RYGB and VSG was associated with generalized improvements in metabolic health and hippocampal-dependent learning, as measured in the radial arm maze and spontaneous alternation tests. However, VSG-treated rats exhibited deficits on spatial learning tasks in the Morris water maze. In addition, whereas VSG animals had elevated hippocampal inflammation, comparable to that of obese controls, RYGB and calorie-restricted (pair-fed, PF) controls exhibited an amelioration of inflammation, as measured by the microglial protein ionized calcium binding adaptor molecule 1 (IBA1). We also assessed whether GHR (ghrelin) replacement would attenuate hippocampal inflammation in VSG, as post-surgical GHR levels are significantly reduced in VSG relative to RYGB and PF rats. However, GHR treatment did not attenuate the hippocampal inflammation. Although VSG was comparably effective at reducing body weight and improving glucose regulation as RYGB, VSG did not appear to confer an equal benefit on cognitive function and markers of inflammation.

  18. Comparison of the Effect of Gastric Bypass and Sleeve Gastrectomy on Metabolic Syndrome and its Components in a Cohort: Tehran Obesity Treatment Study (TOTS).

    Science.gov (United States)

    Barzin, Maryam; Motamedi, Mohammad Ali Kalantar; Serahati, Sara; Khalaj, Alireza; Arian, Peyman; Valizadeh, Majid; Khalili, Davood; Azizi, Fereidoun; Hosseinpanah, Farhad

    2017-07-01

    Metabolic syndrome (MetS) is a prevalent counterpart of morbid obesity. With the surgical technique of sleeve gastrectomy (SG) gaining widespread acceptance for weight loss in morbid obese patients, we aimed to undertake a study to compare its effectiveness to gastric bypass (GB) for metabolic control in these patients. A total of 425 patients from a prospectively collected database of morbid obese subjects between 18 and 65 years of age undergoing a primary bariatric procedure from March 2013 to September 2015 were included. Statistical analysis was performed using general estimation equation and propensity scores, and odds ratios were calculated. Three hundred nineteen patients underwent SG and 106 underwent GB. Mean age of the patients was 37.8 ± 11.7, and mean body mass index (BMI) was 44.3 ± 5.9 kg/m 2 . MetS was present in 61.4% of patients and diabetes mellitus in 48.6%. MetS prevalence decreased from 60 and 64% in the SG and GB groups to 16 and 10% at 12 months, respectively. These improvements were consistent throughout the study period in both groups, with no significant difference between the two groups (for all variables: P trend   .05). After propensity score-adjusted analysis, neither surgical technique showed superiority over the other regarding metabolic improvement (OR for MetS resolution: 0.81, 95% CI: 0.49-1.34). In this short-term study with 1-year follow-up, SG showed similar results to GB in terms of weight loss, MetS resolution, and glycemic control in a large Middle Eastern cohort. Long-term studies are needed to further investigate the effectiveness of SG in this regard.

  19. Impact of post-laparoscopic sleeve gastrectomy weight loss on C-reactive protein, lipid profile and CA-125 in morbidly obese women.

    Science.gov (United States)

    Morshed, Ghada; Fathy, Samah M

    2016-01-01

    Obesity increases production of adipose tissue-derived proteins, such as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). Also there are elevated levels of C-reactive protein (CRP) and IL-6, CD8, and CD4, indicating chronic subclinical inflammation. Since obesity represents a serious risk factor in several metabolic diseases, identifying the status of carbohydrate antigen-125 (CA-125) would further link obesity and tumors. To examine the effect of weight loss by laparoscopic sleeve gastrectomy (LSG) on plasma CRP, lipid profiles and CA-125 level in morbidly obese patients. This prospective study was conducted in the Surgery Department, Fayoum University Hospital, between August 2013 and September 2015. To assess the effect of excess weight loss following this operation CRP, lipid profile and CA-125 were measured before and 12 months after the LSG operation for weight loss. The study included 30 cases of morbidly obese patients: 30 (100%) females aged 23-55 years who were considered clinically obese with a mean body mass index of 42.71 ±4.3 (38-46) kg/m(2) and mean age of 40.3 ±8.5 (23-55) years. The National Institute of Health (NIH) inclusion criteria for bariatric surgery were used. A mean weight loss of 29.30% decreased plasma CRP, triglycerides, total cholesterol and low-density lipoprotein cholesterol (HDL cholesterol), CA-125 level and increased high-density lipoprotein cholesterol (HDL cholesterol) The percentage weight loss was significantly associated with changes in plasma CRP, triglycerides, total cholesterol, total HDL cholesterol and CA-125. Weight loss by LSG improves inflammation, dyslipidemia and CA-125 level.

  20. Sleeve gastrectomy is a safe and efficient procedure in HIV patients with morbid obesity: a case series with results in weight loss, comorbidity evolution, CD4 count, and viral load.

    Science.gov (United States)

    Fysekidis, Marinos; Cohen, Régis; Bekheit, Mohamed; Chebib, Joseph; Boussairi, Abdelghani; Bihan, Hélène; Khuong, Marie Aude; Finkielsztejn, Laurent; Mendoza, Gabriela; Abgrall, Sophie; Condé, Djiba; Catheline, Jean Marc

    2015-02-01

    The efficacy and safety of bariatric surgery have been poorly studied in patients affected with HIV. Although sleeve gastrectomy (SG) is the most widely used procedure in many countries, most of the published literature reported results with the gastric bypass (GBP) procedure on morbidly obese HIV patients. We have evaluated retrospectively, in eight consecutive patients who underwent a SG, its effect in weight loss and its impact on the treatment and on the markers of HIV infection. Seven out of eight patients were females. The mean age was 46 years, with a median preoperative BMI of 42 kg/m(2). The mean duration of HIV infection and CD4 cell count were 13.4 years and 457 cells/mm(3), respectively. The mean weight loss was 37 kg in 20 months, the excess BMI loss was 80.8 ± 30.9 %, and the excess weight loss is 81.5 ± 28.9 % with one minor complication. CD4 counts were unchanged. Three patients had therapy modifications that were unrelated to bariatric surgery. Two patients had a therapeutic drug monitoring before and after the intervention. Plasma concentrations remained in therapeutic levels after the SG. Most comorbidities disappeared postoperatively, decreasing the cardiovascular risk. The sleeve gastrectomy was safe and effective with no consequences on CD4 counts and viral load in HIV-affected obese patients. It should be considered as a part of the treatment in morbidly obese HIV patients.

  1. Cardiovascular Risk Factors After Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S): a New Effective Therapeutic Approach?

    Science.gov (United States)

    Torres, Antonio; Rubio, Miguel A; Ramos-Leví, Ana M; Sánchez-Pernaute, Andrés

    2017-11-07

    Obesity and its associated comorbidities entail a significantly increased cardiovascular mortality. Therefore, approaching obesity control must include among its aims the reduction of the associated comorbidities and the higher cardiovascular mortality risk and not only weight loss. Many observational studies indicate that bariatric surgery (BS) is associated with a better long-term survival than standard care. Furthermore, in general, these epidemiological studies included patients who underwent gastric bypass (GB), not biliopancreatic diversion/duodenal switch (BPD/DS), so the potential additional benefit of this latter technique remains unknown. In this regard, in theory, derivative techniques are usually associated to a higher rate of long-term improvement of metabolic comorbidities, so their potential impact on cardiovascular morbidity and mortality could be even greater than what has been published up to date. In 2007, our group proposed a simplification of the bariatric technique based on the duodenal switch, which we termed "single anastomosis duodeno-ileal bypass with sleeve gastrectomy" or SADI-S. In this review, and 10 years later, we describe some of the main results of those patients who underwent this procedure, specifically regarding their outcome on metabolic comorbidities and cardiovascular risk. Considering the findings presented in this review, in which a significant improvement of all metabolic comorbidities was observed, we may confidently suggest that SADI-S seems comparable to a BPD/DS procedure in the mid-term outcome. After all, the SADI-S procedure was conceived as a simplified version of the BPD/DS technique and not necessarily intended to maximize the improvement of cardiovascular and metabolic comorbidities, which is already sufficiently optimal. In this regard, in our experience, we have encountered a new satisfactory result, which combines more pros than cons. In fact, as we have seen, after a follow-up of 3 years, the outcomes of

  2. Effect of Peritoneal Lavage with Clindamycin-Gentamicin Solution on Post-Operative Pain and Analytic Acute-Phase Reactants after Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Llavero, Carolina; Muñoz, Jose Luis; Zubiaga, Lorea; Diez, Maria

    2016-06-01

    Peritoneal lavage has been proposed to remove bacterial contamination and other materials promoting bacterial proliferation and pro-inflammatory cytokines that may enhance local inflammation. The aims of this study were to evaluate the effects of peritoneal lavage with physiologic saline or an antibiotic solution (clindamycin-gentamicin) on post-operative pain and analytic acute-phase reactants and to determine the microbiologic impact of both irrigations on peritoneal contamination in patients undergoing laparoscopic sleeve gastrectomy (LSG) as a bariatric procedure. The patients were randomized into two groups: Those undergoing an intra-abdominal lavage with physiologic saline (Group 1; n = 40) and those undergoing a similar lavage with a gentamicin-clindamycin solution (Group 2; n = 40). Peritoneal contamination, post-operative pain, and analytic acute-phase reactants 24 h after surgery were investigated. The median pain score 24 h after surgery was 3.5 in Group 1 and 1.5 in Group 2 (p = 0.021). The glucose concentration (mean difference 33.1 mg/dL; p = 0.004), aspartate aminotransferase (AST) concentration (mean difference 41.8 U/L; p = 0.009), alanine aminotransferase (ALT) concentration (mean difference 34.2 U/L; p = 0.029), white blood cell count (mean difference 1930/mm(3); p = 0.029); C-reactive protein concentration (mean difference 27.3 mg/L; p = 0.036), and serum lactic acid concentration (mean difference 0.34 mg/L; p = 0.049) were significantly higher in Group 1. Peritoneal contamination also was significantly higher in Group 1 (17.5% vs 0; p = 0.006). Intra-peritoneal irrigation with a gentamicin and clindamycin solution in patients undergoing LSG leads to a reduction in post-operative pain and peritoneal contamination, less alteration of acute-phase reactants, lower blood glucose concentration, a smaller increase in liver enzymes, and a shorter hospital stay.

  3. Sleeve gastrectomy and Roux-en-Y gastric bypass exhibit differential effects on food preferences, nutrient absorption and energy expenditure in obese rats.

    Science.gov (United States)

    Saeidi, N; Nestoridi, E; Kucharczyk, J; Uygun, M K; Yarmush, M L; Stylopoulos, N

    2012-11-01

    All available treatments directed towards obesity and obesity-related complications are associated with suboptimal effectiveness/invasiveness ratios. Pharmacological, behavioral and lifestyle modification treatments are the least invasive, but also the least effective options, leading to modest weight loss that is difficult to maintain long-term. Gastrointestinal weight loss surgery (GIWLS) is the most effective, leading to >60-70% of excess body weight loss, but also the most invasive treatment available. Sleeve gastrectomy (SGx) and Roux-en-Y gastric bypass (RYGB) are the two most commonly performed GIWLS procedures. The fundamental anatomic difference between SGx and RYGB is that in the former procedure, only the anatomy of the stomach is altered, without surgical reconfiguration of the intestine. Therefore, comparing these two operations provides a unique opportunity to study the ways that different parts of the gastrointestinal (GI) tract contribute to the regulation of physiological processes, such as the regulation of body weight, food intake and metabolism. To explore the physiologic mechanisms of the two procedures, we used rodent models of SGx and RYGB to study the effects of these procedures on body weight, food intake and metabolic function. Both SGx and RYGB induced a significant weight loss that was sustained over the entire study period. SGx-induced weight loss was slightly lower compared with that observed after RYGB. SGx-induced weight loss primarily resulted from a substantial decrease in food intake and a small increase in locomotor activity. In contrast, rats that underwent RYGB exhibited a substantial increase in non-activity-related (resting) energy expenditure and a modest decrease in nutrient absorption. Additionally, while SGx-treated animals retained their preoperative food preferences, RYGB-treated rats experienced a significant alteration in their food preferences. These results indicate a fundamental difference in the mechanisms of

  4. Combined Non-alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus: Sleeve Gastrectomy or Gastric Bypass?-a Controlled Matched Pair Study of 34 Patients.

    Science.gov (United States)

    Billeter, Adrian T; Senft, Jonas; Gotthardt, Daniel; Knefeli, Philipp; Nickel, Felix; Schulte, Thilo; Fischer, Lars; Nawroth, Peter P; Büchler, Markus W; Müller-Stich, Beat P

    2016-08-01

    Although all bariatric procedures improve non-alcoholic fatty liver disease (NAFLD) in metabolically sick obese patients, it remains unclear whether different procedures achieve similar effects. Sleeve gastrectomy (SG) and Roux-Y-gastric bypass (RYGB) were compared for their effects on liver function tests (LFT) and glycemic control in a highly selected group of metabolically sick obese patients with both elevated alanine aminotransferase (ALT), a common marker for NAFLD and type 2 diabetes mellitus (T2DM). Thirty-four obese patients with a body mass index (BMI) >35 kg/m(2), ALT > 35 U/L, and T2DM were well-matched from a prospective database and retrospectively analyzed. Seventeen patients each underwent RYGB and SG, respectively. The effects on LFT and glycemic control were evaluated over 12 months. Both procedures significantly lowered ALT and aspartate aminotransferase (AST) after 12 months, but SG improved both LFT significantly better than RYGB (ALT 17.8 ± 8.8 vs. 31.1 ± 11.2 U/L, p = 0.003; AST 17.0 ± 8.8 vs. 24.3 ± 7.5 U/L, p = 0.004). In contrast to RYGB, SG normalized elevated ALT levels completely (41 vs. 0 %, p = 0.007). Both SG and RYGB improved insulin resistance, glycemic control, and reduced the need of insulin significantly without any difference between the procedures. SG appears to improve LFT better than RYGB in well-matched obese patients with both elevated ALT and T2DM. This suggests that SG may have a better effect on NAFLD than RYGB with similar effects on glycemic control. The present findings should be verified in randomized controlled trials to obtain further evidence for the decision-making on the most appropriate bariatric procedure for metabolically sick patients.

  5. Evaluation of Metabolic Syndrome in morbidly Obese Patients Submitted to Laparoscopic Bariatric Surgery: Comparison of the Results between Roux-En-Y Gastric Bypass and Sleeve Gastrectomy.

    Science.gov (United States)

    Menguer, Rodrigo Koprovski; Weston, Antônio Carlos; Schmid, Helena

    2017-07-01

    Morbid obesity is a state of insulin resistance combined with excess of visceral fat, which contributes to the development of metabolic syndrome (MetS). Nonsurgical treatment of obesity usually improves MetS, but there is no ultimate resolution and weight regain is common. Surgical options like Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) result in a significant and sustained weight loss accompanied by improvement of MetS. The aim of this study was to compare the weight loss and improvement of MetS parameters between degree II and III obese patients with MetS undergoing RYGB or SG in a period of 12 months. Analysis of medical records of 102 patients diagnosed with MetS (63 undergoing RYGB and 39 undergoing SG) in a reference center (CTO ISCMPA) between 2010 and 2013. After 1-year follow-up, an excess weight loss (EWL) of 77.2 ± 22.5% and of 63.4 ± 20.1% (p = 0.033) was observed in the RYGB and SG groups, respectively. The rate of MetS resolution was very similar (87.3 and 84.6%, respectively; p = 0.971). The percentage of patients with type 2 diabetes was 3.3% for RYGB and 15.4% for SG (p = 0.025). Fasting blood glucose levels followed the same trend with mean values reaching 87.6 ± 16.9 mg/dl in the RYGB group and 97.7 ± 35.5 mg/dl in the group undergoing SG (p = 0.023). Among the patients studied, both surgical techniques were safe and effective for MetS resolution in 12 months. However, RYGB was more effective for EWL and improvement of some parameters related to glucose metabolism.

  6. Laparoscopic conversion of sleeve gastrectomy to a biliopancreatic diversion with duodenal switch or a Roux-en-Y gastric bypass due to weight loss failure: our algorithm.

    Science.gov (United States)

    Carmeli, Idan; Golomb, Inbal; Sadot, Eran; Kashtan, Hanoch; Keidar, Andrei

    2015-01-01

    Failed sleeve gastrectomy (SG), defined by inadequate weight loss or weight regain, can be treated by a laparoscopic conversion to a biliopancreatic diversion with duodenal switch (DS) or a Roux-en-Y gastric bypass (RYGB). We report the outcomes of these procedures after SG failure. All patients who underwent DS (n=9) or RYGB (n=10) due to inadequate weight loss or weight regain between December 2006 and November 2012 after a failed SG were enrolled. The mean pre-SG weight and body mass index (BMI) for the DS and RYGB patients were 143±36 kg and 51.5±11 kg/m2 and 120±26 kg and 44.5±5 kg/m2, respectively. The interval between the SG and the conversion to DS and to RYGB was 27±18 months and 36±17 months, respectively. The operation time and hospital stay were 191±64 minutes and 4.3±2.4 days for DS, and 111±37 minutes and 3.1±1.1 days for RYGB. At reoperation, the weight, BMI and percentage of excess weight loss (%EWL) were 113±22 kg, 43±6 kg/m2 and 28±16.5% and 107±27.5 kg, 40±5.7 kg/m2 and 25±12.7% (all P>.05), for the DS and RYGB, respectively. None of the patients were lost to follow-up. The post-DS weight, BMI, and %EWL were 84±19 kg, 30.7±7.4 kg/m2, and 80±40%. The post-RYGB weight, BMI, and %EWL were 81±21 kg, 30.2±4.8 kg/m2, and 65.5±34% (all P>.05). DS and RYGB are feasible and effective operations after a failed SG. The DS yields a greater weight loss. The mechanism of failure should guide selection of the second procedure. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  7. Comparing Outcomes of Two Types of Bariatric Surgery in an Adolescent Obese Population: Roux-en-Y Gastric Bypass versus Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Giovana D Maffazioli

    2016-07-01

    Full Text Available Background: Obesity is prevalent among adolescents and is associated with serious health consequences. Roux-en-Y Gastric Bypass (RYGB and Sleeve Gastrectomy (SG are bariatric procedures that cause significant weight loss in adults and are increasingly being performed in adolescents with morbid obesity. Data comparing outcomes of RYGB versus SG in this age-group are scarce. This study aims to compare short-term (1-6 months and longer-term (7-18 months body mass index (BMI and biochemical outcomes following RYGB and SG in adolescents/young adults.Methods: A retrospective study using data extracted from medical records of patients 16-21 years who underwent RYGB or SG between 2012-2014 at a tertiary care academic medical center. Results: Forty-six patients were included in this study: 24 underwent RYGB and 22 underwent SG. Groups did not differ for baseline age, sex, race or BMI. BMI reductions were significant at 1-6 months and 7-18 months within groups (p<0.0001, but did not differ by surgery type (p= 0.65 and 0.09, for 1-6 months and 7-18 months, respectively. Over 7-18 months, within-group improvement in low density lipoprotein (LDL (-24±6 in RYGB, p=0.003, vs. -7±9mg/dL in SG, p=0.50 and non-high density lipoprotein (non-HDL cholesterol (-23±8 in RYGB, p=0.02, vs. -12±7 in SG, p=0.18 appeared to be of greater magnitude following RYGB. However, differences between groups did not reach statistical significance. When divided by non-alcoholic steatohepatitis stages (NASH, patients with Stage II-III NASH had greater reductions in ALT levels vs. those with Stage 0-I NASH (-45±18 vs -9±3, p=0.01 after 7-18 months. RYGB and SG groups did not differ for the magnitude of post-surgical changes in liver enzymes. Conclusion: RYGB and SG did not differ for the magnitude of BMI reduction across groups, though changes trended higher following RYGB. Further prospective studies are needed to confirm these findings.

  8. Two-step conversion surgery after failed laparoscopic adjustable gastric banding. Comparison between laparoscopic Roux-en-Y gastric bypass and laparoscopic gastric sleeve.

    Science.gov (United States)

    Carandina, Sergio; Maldonado, Pablo S; Tabbara, Malek; Valenti, Antonio; Rivkine, Emmanuel; Polliand, Claude; Barrat, Christophe

    2014-01-01

    Despite its worldwide popularity, laparoscopic adjustable gastric banding (LAGB) requires revisional surgery for failures or complications, in 20-60% of cases. The purpose of this study was to compare in terms of efficacy and safety, the conversion of failed LAGB to laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy. (LSG). The bariatric database of our institution was reviewed to identify patients who had undergone conversion of failed LAGB to LRYGB or to LSG, from November 2007 to June 2012. A total of 108 patients were included. Of these, 74 (68.5%) underwent conversion to LRYGB and 34 to LSG. All of the procedures were performed in 2-stage and laparoscopically. The mean follow-up for the LRYGB group was 29.1±17.9 months while for the LSG patients was 24.2±14.3 months. The mean body mass index (BMI) prior LRYGB and LSG was 45.6±7.8 and 47.5±5.6 (P = .09), respectively. Postoperative complications occurred in 16.2% of the LRYGB patients and in 2.9% of the LSG group (P = .04). Mean percentage of excess weight loss was 59.9%±16.2% and 70.2%±16.7% in LRYGB, and it was 52.2%±11.4% and 59.9%±14.4% in LSG at 12 months (P = .007) and 24 months (P = .01) after conversion. In this series, LRYGB and LSG are both effective and adequate revisional procedure after failure of LAGB. While LRYGB seems to ensure greater weight loss at 24 months follow-up, LSG is associated with a lower postoperative morbidity. Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  9. Serum concentrations and subcutaneous adipose tissue mRNA expression of omentin in morbid obesity and type 2 diabetes mellitus: the effect of very-low-calorie diet, physical activity and laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Urbanová, M; Dostálová, I; Trachta, P; Drápalová, J; Kaválková, P; Haluzíková, D; Matoulek, M; Lacinová, Z; Mráz, M; Kasalický, M; Haluzík, M

    2014-01-01

    Omentin is a novel adipokine with insulin-sensitizing effects expressed predominantly in visceral fat. We investigated serum omentin levels and its mRNA expression in subcutaneous adipose tissue (SCAT) of 11 women with type 2 diabetes mellitus (T2DM), 37 obese non-diabetic women (OB) and 26 healthy lean women (C) before and after various weight loss interventions: 2-week very-low-calorie diet (VLCD), 3-month regular exercise and laparoscopic sleeve gastrectomy (LSG). At baseline, both T2DM and OB groups had decreased serum omentin concentrations compared with C group while omentin mRNA expression in SCAT did not significantly differ among the groups. Neither VLCD nor exercise significantly affected serum omentin concentrations and its mRNA expression in SCAT of OB or T2DM group. LSG significantly increased serum omentin levels in OB group. In contrast, omentin mRNA expression in SCAT was significantly reduced after LSG. Baseline fasting serum omentin levels in a combined group of the studied subjects (C, OB, T2DM) negatively correlated with BMI, CRP, insulin, LDL-cholesterol, triglycerides and leptin and were positively related to HDL-cholesterol. Reduced circulating omentin levels could play a role in the etiopathogenesis of obesity and T2DM. The increase in circulating omentin levels and the decrease in omentin mRNA expression in SCAT of obese women after LSG might contribute to surgery-induced metabolic improvements and sustained reduction of body weight.

  10. Long-term effects of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for the treatment of morbid obesity: a monocentric prospective study with minimum follow-up of 5 years.

    Science.gov (United States)

    Perrone, Federico; Bianciardi, Emanuela; Ippoliti, Simona; Nardella, Jennifer; Fabi, Francesco; Gentileschi, Paolo

    2017-03-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most widely used bariatric procedures nowadays. The aim of this study was to compare long-term results on weight loss and comorbidities improvement for both procedures. A cohort of 304 consecutive patients underwent surgery in 2006-2009: 162 underwent LSG and 142 underwent LRYGB. The mean follow-up time was 75.8 ± 8.4 months (range 60-96). LSG showed greater effectiveness in percentage of excess weight loss (%EWL) at 180 days and at 1 year of follow-up. Instead, at 5th year follow-up LRYGB and LSG showed similar %EWL values (72.34 versus 70.26). LSG group showed a lack of weight loss in patients from 3 to 5 years after surgery, whereas LRYGB group patients maintained an effective weight loss during the entire follow-up period. In LSG group both length of stay and operative time were found to be shorter. LRYGB showed better effectiveness in type 2 diabetes mellitus (T2DM) resolution rate. None of the two techniques has proven to be clearly better than the other on a long-term follow-up analysis, except for the LRYGB better results in T2DM healing. According to our findings, in LSG Group after 3 years the weight remains stable.

  11. The Effect of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy Surgery on Dietary Intake, Food Preferences, and Gastrointestinal Symptoms in Post-Surgical Morbidly Obese Lebanese Subjects: A Cross-Sectional Pilot Study.

    Science.gov (United States)

    El Labban, Sibelle; Safadi, Bassem; Olabi, Ammar

    2015-12-01

    Data on gastrointestinal (GI) and dietary changes following bariatric surgery are scarce in the Middle Eastern region. The objective of this work was to retrospectively compare dietary intake, food preferences, and GI symptoms in subjects with extreme obesity after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Sixty subjects equally divided between RYGB and SG with a postoperative period of ≥6 months were recruited for a retrospective, non-randomized, and observational study. All subjects completed three questionnaires (GI symptoms, food preferences, and quantitative food frequency questionnaire (FFQ)) and three 24-h recalls. At one year postoperatively, both surgical groups showed similar percentage of excess weight loss that exceeded 50%. In addition, percentage of carbohydrate, protein, and sugar intake from total energy, frequency of daily consumption from the eight food categories and daily energy intake were comparable between surgical groups. RYGB subjects consumed significantly more fruits and juices from total energy (P fast heartbeat (P food preferences between RYGB and SG groups. There was a trend for sweet-eating in SG subjects with less dumping symptoms to suggest different mechanisms of action for each procedure, which might impact eating behavior.

  12. Comparative Effects of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on Glucose Homeostasis and Incretin Hormones in Obese Type 2 Diabetic Patients: A One-Year Prospective Study.

    Science.gov (United States)

    Nosso, G; Griffo, E; Cotugno, M; Saldalamacchia, G; Lupoli, R; Pacini, G; Riccardi, G; Angrisani, L; Capaldo, B

    2016-05-01

    The aim of the work was to compare the hormonal and the metabolic mechanisms involved in weight loss and remission of T2DM one year after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) in morbidly obese type 2 diabetic (T2DM) patients. Insulin sensitivity, insulin secretion, and the gastrointestinal (GI) hormone response to a mixed meal test (MMT) were evaluated before and one year after BS (14 RYGB and 19 VSG). RYGB and VSG groups had similar characteristics at baseline. Weight loss at one year was similar in the 2 groups (ΔBMI%: - 32±10 and - 30±7%, p=0.546). Insulin sensitivity and insulin secretion improved similarly after either procedures with a similar rate in T2DM remission (86% in RYGB and 76% in VSG). Meal-stimulated GLP-1 levels increased after both procedures reaching significantly higher levels after RYGB (p=0.0001). GIP response to MMT decreased to a similar extent after the 2 interventions (p=0.977). Both fasting and post-meal ghrelin concentrations were markedly suppressed after VSG and significantly lower than RYGB (p=0.013 to p=0.035). The improvement of insulin sensitivity and beta-cell function was significantly associated with weight loss (p=0.014 to p=0.035), while no relation was found with the changes in GI hormones. In conclusion, in morbidly obese T2DM patients, RYGB and VSG result in similar improvements of the glucose status in the face of different GI hormonal pattern. Weight loss is the key determinant of diabetes remission one year after surgery. © Georg Thieme Verlag KG Stuttgart · New York.

  13. A 7-Year Clinical Audit of 1107 Cases Comparing Sleeve Gastrectomy, Roux-En-Y Gastric Bypass, and Mini-Gastric Bypass, to Determine an Effective and Safe Bariatric and Metabolic Procedure.

    Science.gov (United States)

    Jammu, Gurvinder S; Sharma, Rajni

    2016-05-01

    The epidemic of obesity is engulfing developed as well as developing countries like India. We present our 7-year experience with laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and mini-gastric bypass (MGB) to determine an effective and safe bariatric and metabolic procedure. The study is an analysis of a prospectively collected bariatric database of 473 MGBs, 339 LSGs, and 295 RYGBs. Mortality rate was 2.1% in LSG, 0.3% in RYGB, and 0% in MGB. Leaks were highest in LSG (1.5%), followed by RYGB (0.3%), and zero in MGB. Bile reflux was seen in RYGB, but 0% in MGB. Hypoalbuminemia was minimal in LSG, 2.0% in RYGB, and 13.1% in MGB (in earlier patients where bypass was >250 cm). The following resolution of comorbidities: dyslipidemia, type 2 diabetes (T2D), hypertension, and percent excess weight loss (%EWL) was maximum in MGB. GERD was maximum in LSG (9.8%), followed by RYGB (1.7%), and minimal in MGB (0.6%). RYGB and MGB act on the principle of restriction and malabsorption, but MGB superseded RYGB in its technical ease, efficacy, revisibility, and reversibility. Mortality was zero in MGB. %EWL and resolution of comorbidities were highly significant in MGB. Based on this audit, we suggest that MGB is the effective and safe procedure for patients who are compliant in taking their supplements. LSG may be done in non-compliant patients and those ready to accept weight regain.

  14. The Change in the Percent of Android and Gynoid Fat Mass Correlated with Increased Testosterone After Laparoscopic Sleeve Gastrectomy in Chinese Obese Men: a 6-Month Follow-Up.

    Science.gov (United States)

    Gao, Jingyang; Zhang, Manna; Zhu, Cuiling; Zhang, Yi; Liu, Qi; Wang, Xingchun; Li, Liang; Zhou, Donglei; Qu, Shen

    2018-02-07

    The study was designed to examine changes of body fat distribution after laparoscopic sleeve gastrectomy (LSG) in obese male patients and to confirm whether these changes are correlated with increased testosterone. A total of 30 obese male patients with body mass index (BMI) 30-45 kg/m 2 were enrolled in this study. Data on demographic characteristics, anthropometry, metabolic parameters, and body fat distribution were collected at baseline and 6 months after LSG. Body fat distribution was assessed by dual-energy X-ray absorptiometry (DXA). Six months after surgery, the BMI of participants (age 33.0 ± 9.5) decreased from 40.2 ± 5.2 to 30.8 ± 4.4 kg/m 2 , total testosterone increased from 2.4 ± 1.2 to 4.5 ± 1.8 ng/mL, and the percentage of testosterone deficiency in these patients decreased from 82.7 to 23.1%. Fat mass was significantly decreased in all regions, but the loss of fat mass in the android region was more than that in any other body region. After adjusting age and the BMI, the changes in android FM% and gynoid FM% were significantly correlated with an increase in total testosterone concentration (R 2  = 0.187, R 2  = 0.282, respectively). In obese male patients with BMI 30-45 kg/m 2 , an increase of total testosterone correlated to the changes in android FM% and gynoid FM% at the sixth month after LSG surgery.

  15. Differential Acute Impacts of Sleeve Gastrectomy, Roux-en-Y Gastric Bypass Surgery and Matched Caloric Restriction Diet on Insulin Secretion, Insulin Effectiveness and Non-Esterified Fatty Acid Levels Among Patients with Type 2 Diabetes.

    Science.gov (United States)

    Thomas, Felicity; Smith, Greg C; Lu, Jun; Babor, Richard; Booth, Michael; Beban, Grant; Chase, J Geoffrey; Murphy, Rinki

    2016-08-01

    Bariatric surgery is an increasingly common option for control of type 2 diabetes (T2D) and obesity. Mechanisms underlying rapid improvement of T2D after different types of bariatric surgery are not clear. Caloric deprivation and altered levels of non-esterified fatty acid (NEFA) have been proposed. This study examines how sleeve gastrectomy (SG), Roux-en-Y gastric bypass (GBP) or matched hypocaloric diet (DT) achieves improvements in T2D by characterising components of the glucose metabolism and NEFA levels before and 3 days after each intervention. Plasma samples at five time points during oral glucose tolerance test (OGTT) from subjects with T2D undergoing GBP (N = 11) or SG (N = 12) were analysed for C-peptide, insulin and glucose before surgery and 3-day post-intervention or after DT (N = 5). Fasting palmitic, linoleic, oleic and stearic acid were measured. C-peptide measurements were used to model insulin secretion rate (ISR) using deconvolution. Subjects who underwent GBP surgery experienced the greatest improvement in glycaemia (median reduction in blood glucose (BG) from basal by 29 % [IQR -57, -18]) and the greatest reduction in all NEFA measured. SG achieved improvement in glycaemia with lower ISR and reduction in all but palmitoleic acid. DT subjects achieved improvement in glycaemia with an increase in ISR, 105 % [IQR, 20, 220] and stearic acid. GBP, SG and DT each improve glucose metabolism through different effects on pancreatic beta cell function, insulin sensitivity and free fatty acids.

  16. Preoperative Regular Diet of 900 kcal/day vs Balanced Energy High-Protein Formula vs Immunonutrition Formula: Effect on Preoperative Weight Loss and Postoperative Pain, Complications and Analytical Acute Phase Reactants After Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Zubiaga, Lorea; Diez, Maria; Murcia, Ana; Boix, Evangelina; Muñoz, José Luis; Llavero, Carolina

    2016-06-01

    Between 2 and 8 weeks before surgery, most bariatric surgery groups establish strict dietary treatments with a total caloric intake of less than 1,000 kcal/day in order to maximize weight loss during this period of time. A prospective randomized clinical trial of all the patients undergoing laparoscopic sleeve gastrectomy (LSG) was performed. Patients were randomly assigned into 3 groups: those patients receiving a preoperative regular diet of 900 kcal/day (group 1), those receiving a preoperative balanced energy high-protein formula (group 2) and those receiving preoperative Immunonutrition (group 3). Preoperative weight loss, postoperative pain, complications and analytical acute phase reactants were investigated. Sixty patients were included in the study, 20 in each group. Preoperative excess weight loss was 7.7 % in group 1, 12.3 % in group 2 and 15.3 % in group 3 (p = 0.014). Median postoperative pain was 3.5 in group 1, 3 in group 2 and 2 in group 3 (p = 0.048). C-reactive protein determined 24 h after surgery was significantly lower in group 3 than in the other groups. AST and ALT values were significantly lower in group 3 than in the other groups, without significant differences between groups 1 and 2. Preoperative diet with Immunonutrition formulas during 2 weeks achieves a greater preoperative weight loss, lower postoperative pain and lower values of CRP and liver enzymes than high-protein formulas or regular diet, all of them with similar caloric intake.

  17. Relationship Between Vitamin D Deficiency and the Components of Metabolic Syndrome in Patients with Morbid Obesity, Before and 1 Year After Laparoscopic Roux-en-Y Gastric Bypass or Sleeve Gastrectomy.

    Science.gov (United States)

    Obispo Entrenas, Ana; Legupin Tubio, David; Lucena Navarro, Fabiola; Martin Carvajal, Francisco; Gandara Adan, Norberto; Redondo Bautista, Maximino; Abiles Osinaga, Jimena

    2017-05-01

    Vitamin D deficiency (VDD) is associated with obesity and metabolic syndrome (MS). After bariatric surgery (BS), high rates of VDD often persist and some patients are refractory to the resolution of comorbidities. The aim of the present study is to analyse the relationship between the levels of vitamin D and the persistence of MS components at 12 months after BS, according to the surgical technique used. We performed a retrospective study of 46 patients undergoing BS: 23 underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP) and 23 laparoscopic sleeve gastrectomy (LSG). These patients had an average BMI of 45 kg/m 2 (34-63). Levels of vitamin D were classified as deficient (30 ng/dl) and analysed in relation to the components of MS (high blood pressure (HBP), dyslipidaemia (DL) and type 2 diabetes mellitus (T2DM) preoperatively and 12 months after surgery. VDD was observed in 77% of the patients prior to surgery. There were no significant associations between predisposing factors and baseline vitamin D. After surgery, plasma levels of vitamin D increased in both groups, but only 18% of the patients achieved normal values. Both groups had achieved significant improvements in MS components. Thus, 63% of all the patients achieved complete resolution of HBP, 54% that of DL and 77% that of T2DM. Moreover, MS was present in 11% of the patients, compared to 63% at baseline, and the MS resolution rate was 83%, with no significant differences between LRYGBP and LSG. There is a relationship between VDD and persistence of MS, and particularly so with T2DM. VDD could represent a predictor of MS persistence at 12 months after surgery.

  18. Changes in Non-Diabetic Comorbid Disease Status Following Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-En-Y Gastric Bypass (LRYGB) Procedures: a Systematic Review of Randomized Controlled Trials.

    Science.gov (United States)

    Osland, Emma; Yunus, Rossita Mohamad; Khan, Shahjahan; Memon, Breda; Memon, Muhammed Ashraf

    2017-05-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG) have been proposed as cost-effective strategies to manage obesity-related chronic disease. The aim of this systematic review was to study the peer review literature regarding postoperative nondiabetic comorbid disease resolution or improvement reported from randomized controlled trials (RCTs) comparing LVSG and LRYGB procedures. RCTs comparing postoperative comorbid disease resolution such as hypertension, dyslipidemia, obstructive sleep apnea, joint and musculoskeletal conditions, gastroesophageal reflux disease, and menstrual irregularities following LVSG and LRYGB were included for analysis. The studies were selected from PubMed, Medline, EMBASE, Science Citation Index, Current Contents, and the Cochrane database and reported on at least one comorbidity resolution or improvement. The present work was undertaken according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA). The Jadad method for assessment of methodological quality was applied to the included studies. Six RCTs performed between 2005 and 2015 involving a total of 695 patients (LVSG n = 347, LRYGB n = 348) reported on the resolution or improvement of comorbid disease following LVSG and LRYGB procedures. Both bariatric procedures provide effective and almost comparable results in improving or resolving these comorbidities. This systematic review of RCTs suggests that both LVSG and LRYGB are effective in resolving or improving preoperative nondiabetic comorbid diseases in obese patients. While results are not conclusive at this time, LRYGB may provide superior results compared to LVSG in mediating the remission and/or improvement in some conditions such as dyslipidemia and arthritis.

  19. Postoperative Early Major and Minor Complications in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Meta-Analysis and Systematic Review.

    Science.gov (United States)

    Osland, Emma; Yunus, Rossita Mohamad; Khan, Shahjahan; Alodat, Tareq; Memon, Breda; Memon, Muhammed Ashraf

    2016-10-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG) have been proposed as cost-effective strategies to manage obesity-related chronic disease. The aim of this meta-analysis and systematic review was to compare the "early postoperative complication rate i.e. within 30-days" reported from randomized control trials (RCTs) comparing these two procedures. RCTs comparing the early complication rates following LVSG and LRYGB between 2000 and 2015 were selected from PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane database. The outcome variables analyzed included 30-day mortality, major and minor complications and interventions required for their management, length of hospital stay, readmission rates, operating time, and conversions from laparoscopic to open procedures. Six RCTs involving a total of 695 patients (LVSG n = 347, LRYGB n = 348) reported on early major complications. A statistically significant reduction in relative odds of early major complications favoring the LVSG procedure was noted (p = 0.05). Five RCTs representing 633 patients (LVSG n = 317, LRYGB n = 316) reported early minor complications. A non-statically significant reduction in relative odds of 29 % favoring the LVSG procedure was observed for early minor complications (p = 0.4). However, other outcomes directly related to complications which included reoperation rates, readmission rate, and 30-day mortality rate showed comparable effect size for both surgical procedures. This meta-analysis and systematic review of RCTs suggests that fewer early major and minor complications are associated with LVSG compared with LRYGB procedure. However, this does not translate into higher readmission rate, reoperation rate, or 30-day mortality for either procedure.

  20. Gender Influence on Long-Term Weight Loss and Comorbidities After Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: a Prospective Study With a 5-Year Follow-up.

    Science.gov (United States)

    Perrone, Federico; Bianciardi, Emanuela; Benavoli, Domenico; Tognoni, Valeria; Niolu, Cinzia; Siracusano, Alberto; Gaspari, Achille L; Gentileschi, Paolo

    2016-02-01

    Gender might be important in predicting outcomes after bariatric surgery. The aim of the study was to investigate the influence of gender on long-term weight loss and comorbidity improvement after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). A cohort of 304 consecutive patients underwent surgery in 2006-2009: 162 (98 women, 64 men) underwent LSG and 142 (112 women, 30 men) underwent LRYGB. The mean follow-up time was 75.8 ± 8.4 months (range, 60-96 months). Overall mean (95% CI) reduction in BMI was 23.5 (24.3-22.7) kg/m(2) after 5 years, with no statistical difference between LSG and LRYGB groups (P = 0.94). The overall means ± standard deviations of %EBMIL after 5 years were 78.8 ± 23.5 and 81.6 ± 21.4 in the LSG and LRYGB groups, respectively. Only for LSG group %EBMIL after 24-36 and 60 months differed significantly between male and female patients (P = 0.003 versus P = 0.06 in LRYGB), and 89 versus 90% of patients showed improvements in comorbidities in the LSG and LRYGB groups, respectively. Only two patients (women) were lost to follow-up: 1/162 (0.6%) for LSG at the 4th year and 1/142 (0.7%) for LRYGB to the 5th year. LSG was more effective in obese male than in female patients in terms of %EBMIL, with no difference in comorbidities. LRYGB elicited similar results in both genders in terms of %EBMIL and comorbidities.

  1. A Comparative Study Examining the Impact of a Protein-Enriched Vs Normal Protein Postoperative Diet on Body Composition and Resting Metabolic Rate in Obese Patients after Sleeve Gastrectomy.

    Science.gov (United States)

    Schiavo, Luigi; Scalera, Giuseppe; Pilone, Vincenzo; De Sena, Gabriele; Quagliariello, Vincenzo; Iannelli, Antonio; Barbarisi, Alfonso

    2017-04-01

    We recently showed that an 8-week preoperative protein-enriched diet (PED) is associated with significant reductions in body weight and fat mass (FM) without significant loss of fat-free mass (FFM) in morbidly obese patients scheduled for laparoscopic sleeve gastrectomy (LSG). The objective of this study is to evaluate the impact of PED vs a normal protein diet (NPD) on total weight loss (TWL), FM, FFM, and resting metabolic rate (RMR) in patients after LSG. Before LSG and at 3, 6, and 12 months after, we prospectively measured and compared total body weight (TBW), FM, FFM, and RMR in 60 male patients who received either a NPD (n = 30) with protein intake 1.0 g/kg of ideal body weight, or a PED (n = 30) with protein intake 2.0 g/kg of ideal body weight. Compliance in following the prescribed diet was determined with food frequency questionnaires in all patients. The impact of NPD and PED on renal function was also evaluated. Despite non-significant variation in total body weight (TBW), FM decreased more significantly (p NPD. In addition, the PED group showed a significantly (p NPD group. Both groups showed high compliance in following the prescribed diets, without negative impact on renal function. PED is more effective than NPD in determining FM loss and is associated with a lower decrease in FFM and RMR, without interfering with renal function in male patients after LSG.

  2. Reported appetite, taste and smell changes following Roux-en-Y gastric bypass and sleeve gastrectomy: Effect of gender, type 2 diabetes and relationship to post-operative weight loss.

    Science.gov (United States)

    Makaronidis, Janine M; Neilson, Sabrina; Cheung, Wui-Hang; Tymoszuk, Urszula; Pucci, Andrea; Finer, Nicholas; Doyle, Jacqueline; Hashemi, Majid; Elkalaawy, Mohamed; Adamo, Marco; Jenkinson, Andrew; Batterham, Rachel L

    2016-12-01

    Reduced energy intake drives weight loss following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) procedures. Post-operative changes in subjective appetite, taste, and smell and food preferences are reported and suggested to contribute to reduced energy intake. We aimed to investigate the prevalence of these changes following RYGB and SG and to evaluate their relationship with weight loss. 98 patients post-RYGB and 155 post-SG from a single bariatric centre were recruited to a cross-sectional study. Participants completed a questionnaire, previously utilised in post-operative bariatric patients, to assess the prevalence of post-operative food aversions and subjective changes in appetite, taste and smell. Anthropometric data were collected and percentage weight loss (%WL) was calculated. The relationship between food aversions, changes in appetite, taste and smell and %WL was assessed. The influence of time post-surgery, gender and type 2 diabetes (T2D) were evaluated. Following RYGB and SG the majority of patients reported food aversions (RYGB = 62%, SG = 59%), appetite changes (RYGB = 91%, SG = 91%) and taste changes (RYGB = 64%, SG = 59%). Smell changes were more common post-RYGB than post-SG (RYGB = 41%, SG = 28%, p = 0.039). No temporal effect was observed post-RYGB. In contrast, the prevalence of appetite changes decreased significantly with time following SG. Post-operative appetite changes associated with and predicted higher %WL post-SG but not post-RYGB. Taste changes associated with and predicted higher %WL following RYGB but not post-SG. There was no gender effect post-RYGB. Post-SG taste changes were less common in males (female = 65%, males = 40%, p = 0.008). T2D status in females did not influence post-operative subjective changes. However, in males with T2D, taste changes were less common post-SG than post-RYGB together with lower %WL (RYGB = 27.5 ± 2.7, SG = 14.6 ± 2.1, p = 0.003). Further research is

  3. Improvement in self-reported eating-related psychopathology and physical health-related quality of life after laparoscopic sleeve gastrectomy: A pre-post analysis and comparison with conservatively treated patients with obesity.

    Science.gov (United States)

    Figura, Andrea; Rose, Matthias; Ordemann, Jürgen; Klapp, Burghard F; Ahnis, Anne

    2017-01-01

    The present study examined the effects of laparoscopic sleeve gastrectomy (LSG) on self-reported eating-related psychopathology and health-related quality of life (HRQoL). Outcomes of the LSG group were compared with a group of conservatively treated (CT) patients, who underwent a 1-year multimodal weight reduction group program that included dietary advice, physical exercise, psychoeducation, cognitive-behavioral therapy, training in Jacobson's progressive muscle relaxation, and social group support. The setting was a multidisciplinary obesity center. A sample of 103 patients with obesity were investigated using the Eating Disorder Inventory and the Short Form Health Survey before and, on average, 19 (±5) months after weight loss intervention. Thereof, 63 patients (age 45.6±10.9years, 71.4% females) underwent LSG, and 40 patients (age 50.6±11.3years, 77.5% females) underwent the CT program. Patients were assigned to either the surgical or the nonsurgical intervention group following clinical guidelines and patient preference. In the LSG group, excess weight loss (%EWL) was 53.0±24.0%, and body mass index (BMI) decreased from 51.5±8.1 to 38.0±7.7kg/m 2 . In the CT group, %EWL was 13.9±27.1%, and BMI decreased from 40.3±6.7 to 38.0±7.2kg/m 2 . Significant improvements in eating-related psychopathology were observed in both groups. Although both groups had a similar BMI after the respective interventions, LSG patients reported significantly greater body satisfaction and substantial improvement in perceived physical health from a lower baseline level than CT patients. In the second follow-up year, LSG was associated with greater weight loss from a higher baseline weight, and greater improvements in self-reported eating-related psychopathology and physical HRQoL compared with conservative treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Impact of Sleeve Gastrectomy on Type 2 Diabetes Mellitus, Gastric Emptying Time, Glucagon-Like Peptide 1 (GLP-1), Ghrelin and Leptin in Non-morbidly Obese Subjects with BMI 30-35.0 kg/m2: a Prospective Study.

    Science.gov (United States)

    Vigneshwaran, B; Wahal, Akshat; Aggarwal, Sandeep; Priyadarshini, Pratyusha; Bhattacharjee, Hemanga; Khadgawat, Rajesh; Yadav, Rajkumar

    2016-12-01

    The study was conducted to evaluate the impact of laparoscopic sleeve gastrectomy (LSG) on type 2 diabetes mellitus (T2DM) in patients with a body mass index (BMI) of 30.0-35.0 kg/m 2 . Possible mechanisms, including alterations in gastric emptying time (GET), glucagon-like peptide 1 (GLP-1), ghrelin and leptin, were evaluated. Twenty obese patients with T2DM and with a BMI of 30.0-35.0 kg/m 2 underwent LSG during March 2012 to February 2015. Glycosylated haemoglobin (HbA1c), fasting plasma glucose (FPG) and GET were measured at baseline, 3 months, 6 months, 12 months and 24 months after surgery. Fasting and post-prandial levels of serum GLP-1, ghrelin and leptin were measured pre-operatively and after 3 and 6 months. The average duration of follow-up was 17.6 months, and 10 patients had completed 2 years of follow-up. After 2 years, the average BMI decreased from 33.4 ± 1.2 to 26.7 ± 1.8 kg/m 2 . The mean HbA1c decreased from 8.7 ± 1.6 to 6.7 ± 1.5 %, respectively. Ten patients achieved complete remission. Insulin could be stopped in all six patients who were on it pre-operatively. Meal-stimulated GLP-1 response and serum insulin at 30 min showed a significant increase following surgery. There was a significant decrease in GET. This prospective study confirms the positive impact of LSG on diabetic status of non-morbidly obese patients. The possible mechanisms include the rise in post-prandial GLP-1 level induced by accelerated gastric emptying, leading to an increase in insulin secretion. LSG also leads to decreased ghrelin and leptin levels which may have a role in improving glucose homeostasis after surgery.

  5. [Splenic late infarction after laparoscopic gastrectomy: a case report].

    Science.gov (United States)

    Soriano-Giménez, Víctor; Ruiz de Angulo-Martín, David; Munítiz-Ruiz, Vicente; Ortiz-Escandell, María de Los Ángeles; Martínez-de Haro, Luisa Fernanda; Parrilla-Paricio, Pascual

    2017-12-01

    Laparoscopic gastrectomy has emerged in recent years as an effective technique for the treatment of morbid obesity due to low mortality morbidity rates. Its complications include dehiscence suture line, and others such as splenic infarction. We discuss a case of splenic infarction after laparoscopic gastrectomy. 45 year old male with a BMI of 37.8 kg/m 2 , diabetes-II for 15 years, the last five in treatment with insulin, a fasting blood glucose around 140mg/dl, HbA1c of 7.3mg/dl and microangiopathy diabetic nephropathy. The patient underwent a laparoscopic sleeve gastrectomy and he was discharged from hospital 48hours later. 1 month later he presented at the hospital for epigastric pain and fever up to 40° C. An intra abdominal abscess was detected and there was no leakage. The spleen was normal. He was treated with radiological drainage. 9 months later the patient consulted again due to epigastric pain in upper left quadrant, associated with low-grade fever. Thoraco-abdominal CT images compatible with splenic infarction. Currently patient remains asymptomatic one year after surgery. Laparoscopic sleeve gastrectomy is one of the most popular procedures of bariatric surgery. Less common complications include abscess and the splenic infarction. Usually patients are asymptomatic, but sometimes cause fever and pain. Initial treatment should be conservative. Only in selected cases, would splenectomy be indicated. Splenic infarction is usually an early complication, but we should keep it in mind as a long term complication for patients with persistent fever and abdominal pain after laparoscopic gastrectomy. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  6. Gastric Sleeve Surgery

    Science.gov (United States)

    ... regular exercise has family members who will provide emotional and practical support (like driving to every doctor's visit or buying healthy food ) Preparing for Gastric Sleeve Surgery Preparing for this ...

  7. Wernicke’s encephalopathy after sleeve gastrectomy: Literature review

    Directory of Open Access Journals (Sweden)

    Fernando Pardo-Aranda

    2016-01-01

    Conclusion: Nutritional deficiencies after restrictive procedures are uncommon but easily preventable and can result in life threatening. With the upswing of bariatric surgery, surgeons and emergency physicians should be able to diagnose and treat those complications. Prophylactic thiamine should be administered to patients with predisposing factors.

  8. Fusion of duodeno-ileal omega switch and stomach pouch reconstruction as revisionary surgery for failed laparoscopic adjustable gastric banding and sleeved lesser curvature resection

    Directory of Open Access Journals (Sweden)

    Wojciech K. Karcz

    2016-03-01

    Full Text Available Revisionary bariatric surgery procedures are becoming more frequent. Facing the challenge of complicated digestive tract changes after redo surgery, it is crucial to choose an appropriate method. Duodeno-ileal omega switch (DIOS, with growing clinical value as an easy malabsorptive procedure, has emerged as a treatment option. We would like to present a case of a 52-year-old obese male patient with a history of laparoscopic adjustable gastric banding and removal of a lesser curvature as a revision procedure to restore the restriction. In order to improve the patient’s health outcome, a two-stage re-revision procedure was performed, including DIOS to reduce the weight of the patient and a gastric pouch reconstruction in order to achieve a better satiety effect. This case study illustrates the intrinsic potential of malabsorption surgery and makes us believe that it may be used as the primary operation in two-staged procedures for revisionary surgical treatment.

  9. Eating Habits after Gastrectomy

    OpenAIRE

    新井, 治子; 二渡, 玉江; 伊藤, 善一

    1990-01-01

    Follow-up study of eating habits in patients who had undergone subtotal (44 patients) or total gastrectomy (19 patients) showed that the characteristics of diet and the manner of meal tended to change in this order with time after surgery. The patients were able to follow the general family diet about three months after gastrectomy. Within an additional one or two months, patients usually acquired the habit of taking three meals a day. A constant amount of food in almost every regular meal wa...

  10. Grid sleeve bulge tool

    International Nuclear Information System (INIS)

    Phillips, W.D.; Vaill, R.E.

    1980-01-01

    An improved grid sleeve bulge tool is designed for securing control rod guide tubes to sleeves brazed in a fuel assembly grid. The tool includes a cylinder having an outer diameter less than the internal diameter of the control rod guide tubes. The walls of the cylinder are cut in an axial direction along its length to provide several flexible tines or ligaments. These tines are similar to a fork except they are spaced in a circumferential direction. The end of each alternate tine is equipped with a semispherical projection which extends radially outwardly from the tine surface. A ram or plunger of generally cylindrical configuration and about the same length as the cylinder is designed to fit in and move axially of the cylinder and thereby force the tined projections outwardly when the ram is pulled into the cylinder. The ram surface includes axially extending grooves and plane surfaces which are complimentary to the inner surfaces formed on the tines on the cylinder. As the cylinder is inserted into a control rod guide tube, and the projections on the cylinder placed in a position just below or above a grid strap, the ram is pulled into the cylinder, thus moving the tines and the projections thereon outwardly into contact with the sleeve, to plastically deform both the sleeve and the control rod guide tube, and thereby form four bulges which extend outwardly from the sleeve surface and beyond the outer periphery of the grid peripheral strap. This process is then repeated at the points above the grid to also provide for outwardly projecting surfaces, the result being that the grid is accurately positioned on and mechanically secured to the control rod guide tubes which extend the length of a fuel assembly

  11. Gastric Band Removal in Revisional Bariatric Surgery, One-Step Versus Two-Step: a Systematic Review and Meta-analysis.

    Science.gov (United States)

    Dang, Jerry T; Switzer, Noah J; Wu, Jeremy; Gill, Richdeep S; Shi, Xinzhe; Thereaux, Jérémie; Birch, Daniel W; de Gara, Christopher; Karmali, Shahzeer

    2016-04-01

    We aimed to systematically review the literature comparing the safety of one-step versus two-step revisional bariatric surgery from laparoscopic adjustable gastric banding (LAGB) to Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). There is debate on the safety of removing the gastric band and performing revisional surgery immediately or in a delayed, two-step fashion due to potential higher complications in one-step revisions. A systematic and comprehensive search of the literature was conducted. Included studies directly compared one-step and two-step revisional surgery. Eleven studies were included with 1370 patients. Meta-analysis found comparable rates of complications, morbidity, and mortality between one-step and two-step revisions for both RYGB and SG groups. This suggests that immediate or delayed revisional bariatric surgeries are both safe options for LAGB revisions.

  12. Intrathoracic Hernia after Total Gastrectomy

    Directory of Open Access Journals (Sweden)

    Yoshihiko Tashiro

    2016-05-01

    Full Text Available Intrathoracic hernias after total gastrectomy are rare. We report the case of a 78-year-old man who underwent total gastrectomy with antecolic Roux-Y reconstruction for residual gastric cancer. He had alcoholic liver cirrhosis and received radical laparoscopic proximal gastrectomy for gastric cancer 3 years ago. Early gastric cancer in the remnant stomach was found by routine upper gastrointestinal endoscopy. We initially performed endoscopic submucosal dissection, but the vertical margin was positive in a pathological result. We performed total gastrectomy with antecolic Roux-Y reconstruction by laparotomy. For adhesion of the esophageal hiatus, the left chest was connected with the abdominal cavity. A pleural defect was not repaired. Two days after the operation, the patient was suspected of having intrathoracic hernia by chest X-rays. Computed tomography showed that the transverse colon and Roux limb were incarcerated in the left thoracic cavity. He was diagnosed with intrathoracic hernia, and emergency reduction and repair were performed. Operative findings showed that the Roux limb and transverse colon were incarcerated in the thoracic cavity. After reduction, the orifice of the hernia was closed by suturing the crus of the diaphragm with the ligament of the jejunum and omentum. After the second operation, he experienced anastomotic leakage and left pyothorax. Anastomotic leakage was improved with conservative therapy and he was discharged 76 days after the second operation.

  13. Sleeving nanocelluloses by admicellar polymerization.

    Science.gov (United States)

    Trovatti, Eliane; Ferreira, Adriane de Medeiros; Carvalho, Antonio José Felix; Ribeiro, Sidney José Lima; Gandini, Alessandro

    2013-10-15

    This investigation reports the first application of admicellar polymerization to cellulose nanofibers in the form of bacterial cellulose, microfibrillated cellulose, and cellulose nanowhiskers using styrene and ethyl acrylate. The success of this physical sleeving was assessed by SEM, FTIR, and contact angle measurements, providing an original and simple approach to the modification of cellulose nanofibers in their pristine aqueous environment. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

  14. Reasons and outcomes of laparoscopic revisional surgery after laparoscopic adjustable gastric banding for morbid obesity.

    Science.gov (United States)

    Patel, Sheetal; Eckstein, Jeremy; Acholonu, Emeka; Abu-Jaish, Wasef; Szomstein, Samuel; Rosenthal, Raul J

    2010-01-01

    Laparoscopic adjustable gastric banding (LAGB) is a purely restrictive procedure that has been proved to be an effective tool in achieving weight loss. The low operative morbidity and reversibility are often seen as advantages of this procedure compared with other bariatric approaches. We have attempted to define the reasons for revisional surgery after LAGB and the outcomes. A retrospective review of a prospectively maintained database was performed from February 2001 to October 2008 at a center of excellence after institutional review board approval. The patients who had undergone revisional surgery after primary LAGB were evaluated. Of 343 patients who had undergone primary LAGB, 60 subsequently underwent a revisional procedure. In addition, 28 revisional procedures were performed on patients who had undergone primary LAGB at an outside institution. These procedures included 39 (44.3%) band removals alone, 12 (13.6%) band removals with conversion to sleeve gastrectomy, 13 (14.8%) band removals with conversion to Roux-en-Y gastric bypass, 9 (10.2%) band repositioning, and 2 (2.3%) band replacements. In addition, 13 (14.8%) port-related procedures (3 relocations, 6 reconnections, and 4 replacements/removals) were performed. Although reversible and efficacious, LAGB appears to have a high incidence of complications requiring revisional surgery and/or band removal. The results of our study have shown that laparoscopic revisional surgery after primary LAGB is safe and can be performed with minimal morbidity. Copyright 2010 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  15. Outcomes of Two-Step Revisional Bariatric Surgery: Reasons for the Gastric Banding Explantation Matter.

    Science.gov (United States)

    Barreto, Savio George; Chisholm, Jacob; Schloithe, Ann; Collins, Jane; Kow, Lilian

    2018-02-01

    The purpose of this study is to determine whether the reason for gastric band explantation would influence percentage excess weight loss (%EWL) following revisional Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). This is a retrospective cohort study, whose data are maintained in a prospective surgical database. The study period was from January 2012 to March 2017. Revisional surgeries were performed in a two-step manner, namely, first surgery LAGB explantation and second surgery (RYGB or SG). Two-way between-groups analysis of variance was used to examine effects of reason for band explantation (failed versus complication) and type of revisional surgery (RYGB versus SG) on %EWL at 10 months, 1 and 2 years. Cohort included 171 patients-146 women (85.4%) and 25 men, median age 51 years (range 22-76). Band-related complications accounted for 55% of explantations. Overall, 95 patients (56%) underwent a revisional RYGB, and 76 patients underwent a revisional SG. There was no difference in age or gender in terms of reason for band explantation or choice of revisional surgery. There was no difference in morbidity between the two groups (SG 2.6% versus RYGB 4.2%; p = .464). Patients undergoing revisional RYGB for failed weight loss had a significantly lower %EWL at 2 years compared to patients undergoing an SG for failed weight loss (p = .014) or an RYGB for band-related complications (p = .021). Patients undergoing revisional RYGB following band explantation for failed weight loss have a significantly lower %EWL at 2 years compared to patients undergoing an SG for failed weight loss or an RYGB for band-related complications.

  16. Total gastrectomy for non-neoplastic diseases

    DEFF Research Database (Denmark)

    Bjorn, Niels; Ainsworth, Alan Patrick; Mortensen, Michael Bau

    2017-01-01

    Background: The aim of this study was to describe patients who had total gastrectomy for non-neoplastic diseases within a well-defined geographical area. Material and Methods: Retrospective study of patients who had gastrectomy for a non-neoplastic disease at the Department of Surgery, Odense...... University Hospital from 1 January 2005 to 31 December 2014. Results: A total of 268 gastrectomies were performed with the 10-year period. Of these, ten (4%) were done for non-neoplastic diseases. Two were men and eight women with a median age of 51 years (range 31 to 96 years). Six had emergency surgery...... of 10 and 2 of 10, respectively. Histology of the resected specimens showed: Oedema, inflammation and/or necrosis (n=6), Menetrier's disease (n=2) and perforation (n=2). Conclusions: Gastrectomy for non-neoplastic diseases accounts for less than 5% of all gastrectomies. The majority of these cases...

  17. QUALITY OF LIFE AFTER VERTICAL GASTRECTOMY EVALUATED BY THE BAROS QUESTIONNAIRE.

    Science.gov (United States)

    Mendes, Giselle Abigail; Vargas, Guilherme Pedroso

    2017-01-01

    The satisfactory outcome in the surgical treatment of obesity must include, in addition to weight loss, a significant change in the pre-existing comorbidities and in the quality of life. To evaluate the quality of life in the late postoperative period in patients that underwent videolaparoscopic sleeve gastrectomy. It was applied the questionnaire "Bariatric Analysis and Reporting Outcome System" (BAROS) in patients that underwent videolaparoscopic sleeve gastrectomy. A total of 47 patients between 21-60 years old were evaluated. The total mean of BMI before surgery was 43.06±5.87 kg/m². The average percentage of the reduction of excess weight after surgery was 85.46±23.6%. The score obtained by patients in the questionnaire about the improvement in the quality of life showed excellent (36.17%), very good (40.43%), good (21.28%) and reasonable (2.13%) results. There was clinical improvement after surgery in all comorbidities investigated. The weight loss was critical to improve the quality of life and offered the resolution or clinical improvement in all of the investigated comorbidities in patients submitted to sleeve gastrectomy. O desfecho satisfatório na abordagem cirúrgica da obesidade deve contemplar, além da perda de peso, alteração significativa nas comorbidades preexistentes e na qualidade de vida dos pacientes. Avaliar a qualidade de vida no pós-operatório tardio de pacientes submetidos à cirurgia de gastrectomia vertical por videolaparoscopia. Métodos : Foi aplicado o questionário "Bariatric Analysis and Reporting Outcome System" (BAROS) em pacientes submetidos à gastrectomia vertical por videolaparoscopia. Foram avaliados 47 pacientes, entre 21 e 60 anos de idade. O IMC médio antes da operação era 43,06±5,87 kg/m². A média percentual de redução do excesso de peso após foi de 85,46±23,6%. A pontuação obtida pelos pacientes no questionário sobre a melhora na qualidade de vida evidenciou resultado excelente (36,17%), ótimo (40

  18. Single port Billroth I gastrectomy

    Directory of Open Access Journals (Sweden)

    Jeremy R Huddy

    2013-01-01

    Full Text Available Introduction: Experience has allowed increasingly complex procedures to be undertaken by single port surgery. We describe a technique for single port Billroth I gastrectomy with a hand-sewn intracorporeal anastomosis in the resection of a benign tumour diagnosed incidentally on a background of cholelithiasis. Materials and Methods: Single port Billroth I gastrectomy and cholecystectomy was performed using a transumbilical quadport. Flexible tipped camera and straight conventional instruments were used throughout the procedure. The stomach was mobilised including a limited lymph node dissection and resection margins in the proximal antrum and duodenum were divided with a flexible tipped laparoscopic stapler. The lesser curve was reconstructed and an intracorporal hand sewn two layer end-to-end anastomosis was performed using unidirectional barbed sutures. Intraoperative endoscopy confirmed the anastomosis to be patent without leak. Results: Enteral feed was started on the day of surgery, increasing to a full diet by day 6. Analgesic requirements were a patient-controlled analgesia morphine pump for 4 postoperative days and paracetamol for 6 days. There were no postoperative complications and the patient was discharged on the eighth day. Histology confirmed gastric submucosal lipoma. Discussion: As technology improves more complex procedures are possible by single port laparoscopic surgery. In this case, flexible tipped cameras and unidirectional barbed sutures have facilitated an intracorporal hand-sewn two layer end-to-end anastomosis. Experience will allow such techniques to become mainstream.

  19. Parametric study for design of thermal sleeves

    International Nuclear Information System (INIS)

    Mukherjee, A.B.; Mehra, V.K.

    1985-01-01

    Thermal sleeves are used inside nozzle in many reactor components. Basic aim in design of thermal sleeve is to arrive at a set of dimensions for gap and annulus length, which will give rise to minimum thermal gradient in the base metal of the associated nozzle. Study includes the minimisation of the thermal gradient in the crotch zone by suitable choice of gap and annulus length. Three different geometries of nozzle radii 50.00 mm., 100 mm. and 200.0 mm. are studied for single and two concentric thermal sleeves model. The paper also presents effect of parameters like velocity of flow, temperature of fluid, materials etc. on the design of thermal sleeves. (orig.)

  20. Laparoscopic Sleeve Gastrectomy in a Morbidly Obese Patient with Myasthenia Gravis: A Review of the Management

    Directory of Open Access Journals (Sweden)

    Megana Ballal

    2015-01-01

    Full Text Available Myasthenia gravis, a disorder of neuromuscular transmission, presents a unique challenge to the perioperative anesthetic management of morbidly obese patients. This report describes the case of a 27-year-old morbidly obese woman with a past medical history significant for myasthenia gravis and fatty liver disease undergoing bariatric surgery. Anesthesia was induced with intravenous agents and maintained with an inhalational and balanced intravenous technique. The nondepolarizing neuromuscular blocker Cisatracurium was chosen so that no reversal agents were given. Neostigmine was not used to antagonize the effects of Cisatracurium. The goal of this approach was to reduce the risk of complications such as postoperative mechanical ventilation. The anesthetic and surgical techniques used resulted in an uneventful hospital course. Therefore, we can minimize perioperative risks and complications by adjusting the anesthetic plan based on the patient’s physiology and comorbidities as well as the pharmacology of the drugs.

  1. Rapid and safe learning of robotic gastrectomy for gastric cancer: multidimensional analysis in a comparison with laparoscopic gastrectomy.

    Science.gov (United States)

    Kim, H-I; Park, M S; Song, K J; Woo, Y; Hyung, W J

    2014-10-01

    The learning curve of robotic gastrectomy has not yet been evaluated in comparison with the laparoscopic approach. We compared the learning curves of robotic gastrectomy and laparoscopic gastrectomy based on operation time and surgical success. We analyzed 172 robotic and 481 laparoscopic distal gastrectomies performed by single surgeon from May 2003 to April 2009. The operation time was analyzed using a moving average and non-linear regression analysis. Surgical success was evaluated by a cumulative sum plot with a target failure rate of 10%. Surgical failure was defined as laparoscopic or open conversion, insufficient lymph node harvest for staging, resection margin involvement, postoperative morbidity, and mortality. Moving average and non-linear regression analyses indicated stable state for operation time at 95 and 121 cases in robotic gastrectomy, and 270 and 262 cases in laparoscopic gastrectomy, respectively. The cumulative sum plot identified no cut-off point for surgical success in robotic gastrectomy and 80 cases in laparoscopic gastrectomy. Excluding the initial 148 laparoscopic gastrectomies that were performed before the first robotic gastrectomy, the two groups showed similar number of cases to reach steady state in operation time, and showed no cut-off point in analysis of surgical success. The experience of laparoscopic surgery could affect the learning process of robotic gastrectomy. An experienced laparoscopic surgeon requires fewer cases of robotic gastrectomy to reach steady state. Moreover, the surgical outcomes of robotic gastrectomy were satisfactory. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Getting the most from the sleeve: the importance of post-operative follow-up.

    Science.gov (United States)

    Keren, Dean; Matter, Ibrahim; Rainis, Tova; Lavy, Alexandra

    2011-12-01

    Bariatric approach to obesity provides substantial weight loss and comorbidity resolution. Our unique service includes pre- and postoperative visits to the Health and Nutrition Clinic headed by a specialist in gastroenterology and nutrition. We compared patients attending regular clinic routine with those who were lost to follow-up with regard to anthropometry, comorbidity, quality of life, and food tolerance and determined who benefited most from the operation. A retrospective review was performed on patients 30 months after undergoing sleeve gastrectomy. Body mass index was used to report weight loss. Bariatric Analysis and Reporting Outcome System (BAROS) and Food Tolerance Score were (FTS) completed by all patients at the 30-month follow-up visit and compared between two groups (group I-30 months of active postoperative follow-up; group II-without). A total of 119 patients participated in the study. For groups I and II, the mean percentage of excess BMI loss at 30 months was 82.08 ± 9.83 and 74.88 ± 8.75, respectively, with better comorbidity improvement in group I. BAROS scores were 7.62 ± 0.72 and 6.92 ± 0.92. FTS was 24.30 ± 2.09 and 22.55 ± 2.27, respectively. From our experience, getting the most from the sleeve is attributed to two main factors: surgery and nutrition. Surgery results in optimal restriction and improved satiety, whereas nutrition relies on a professional medical team providing constant, ongoing patient support throughout all the bariatric process stages. These teams of surgeons and gastroenterologists specializing in nutrition, working side by side, each in their area of specialty, are the main pillars leading to the success of the sleeve.

  3. Single Anastomosis Sleeve Ileal Bypass: New Step in the Evolution of Bariatric Surgeries.

    Science.gov (United States)

    Salama, Tamer M S; Sabry, Karim; Ghamrini, Yaser El

    2017-10-01

    Single anastomosis sleeve ileal bypass (SASI) procedure appears as a new metabolic and bariatric surgery based on Santoro's operation, in which a sleeve gastrectomy is followed by a side-to-side gastroileal anastomosis. The study is aimed to evaluate the short-term outcomes of laparoscopic single anastomosis sleeve ileal bypass with respect to postoperative weight loss and metabolic and nutritional effects on patients. Forty-five morbidly obese patients with a mean age of 31.2 years and a mean body mass index (BMI) of 43.2 kg/m 2 underwent SASI bypass. Postoperatively, all patients were followed up at 1, 3, 6, and 12 months, and during each visit data about their BMI, obesity-related comorbidities, and nutritional status were collected. One year after the surgery, mean BMI decreased to 29.1 kg/m 2 and there was significant decrease in plasma level of fasting blood glucose, insulin, and low-density lipoprotein. On the other hand, there was significant increase in high-density lipoprotein plasma level, whereas hemoglobin and albumin plasma level remained normal. Six months after the surgery, calcium plasma level showed mild decrease in two cases, which was improved with multivitamin tablets. In 93% of our patients, multivitamin supplements were stopped after six months of surgery. Laparoscopic SASI bypass has been shown to be an effective, safe, and simple procedure for the treatment of morbid obesity and its associated metabolic consequences. Moreover, it results in minimal postoperative nutritional complications in comparison to other bariatric procedures.

  4. Prevalence of Non-Alcoholic Fatty Liver Disease in Morbidly Obese Patients Undergoing Sleeve Bariatric Surgery in Iran and Association With Other Comorbid Conditions

    Directory of Open Access Journals (Sweden)

    Karimi-Sari

    2015-04-01

    Full Text Available Background Nonalcoholic fatty liver disease (NAFLD is one of the most common causes of chronic liver disease including simple steatosis to nonalcoholic steatohepatitis (NASH. NASH could progress to cirrhosis and liver cancer. The prevalence of NAFLD is increasing by increasing the prevalence of obesity. Objectives This study was designed to determine the prevalence of NASH in morbidly obese patients undergoing sleeve bariatric surgery and its correlation with other comorbidities. Patients and Methods In this analytical cross-sectional study, 114 morbidly obese patients undergoing sleeve gastrectomy were selected. Liver ultrasonography was performed for all patients before surgery and NAFLD existence and its grade was determined by hyperechoic texture and fatty infiltration. The liver enzymes and lipid profile were also measured. Prevalence of NAFLD in these patients and its correlation with other comorbid conditions (e.g. diabetes mellitus, hyperlipidemia, hypertension, hypothyroidism and ischemic heart disease were evaluated by SPSS software version 18. Results One hundred fourteen patients with a mean age of 33.96 ± 9.92 years and mean BMI of 43.61 ± 5.77 kg/m2 were enrolled (48 males and 66 females. The prevalence of NAFLD was 16.7%. NAFLD existence was associated with systolic blood pressure, hyperlipidemia, hemoglobin, hematocrit, triglyceride, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and potassium (P < 0.05. Conclusions According to high prevalence of NAFLD in morbidly obese patients undergoing sleeve gastrectomy in Iran, we suggest using gold standard diagnostic method to determine the exact NAFLD prevalence and evaluation of impact of sleeve surgery on NAFLD in short and long term follow-up periods.

  5. Pressurizer with a mechanically attached surge nozzle thermal sleeve

    Energy Technology Data Exchange (ETDEWEB)

    Wepfer, Robert M

    2014-03-25

    A thermal sleeve is mechanically attached to the bore of a surge nozzle of a pressurizer for the primary circuit of a pressurized water reactor steam generating system. The thermal sleeve is attached with a series of keys and slots which maintain the thermal sleeve centered in the nozzle while permitting thermal growth and restricting flow between the sleeve and the interior wall of the nozzle.

  6. The TaSST: Tactile sleeve for social touch

    NARCIS (Netherlands)

    Huisman, Gijs; Darriba Frederiks, Aduén; van Dijk, Elisabeth M.A.G.; Heylen, Dirk K.J.; Krose, Ben

    In this paper we outline the design process of the TaSST (Tactile Sleeve for Social Touch), a touch-sensitive vibrotactile arm sleeve. The TaSST was designed to enable two people to communicate different types of touch over a distance. The touch-sensitive surface of the sleeve consists of a grid of

  7. The TaSST: Tactile Sleeve for Social Touch

    NARCIS (Netherlands)

    Huisman, G.; Darriba Frederiks, A.; van Dijk, B.; Heylen, D.; Kröse, B.

    2013-01-01

    In this paper we outline the design process of the TaSST (Tactile Sleeve for Social Touch), a touch-sensitive vibrotactile arm sleeve. The TaSST was designed to enable two people to communicate different types of touch over a distance. The touch-sensitive surface of the sleeve consists of a grid of

  8. The TaSST - Tactile Sleeve for Social Touch

    NARCIS (Netherlands)

    Huisman, Gijs; Darriba Frederiks, Aduén; Van Dijk, Betsy; Heylen, Dirk

    2013-01-01

    In this paper we outline the design process of TaSST (Tactile Sleeve for Social Touch), a touch-sensitive vibrotactile arm sleeve. The TaSST was designed to enable two people to communicate different types of touches over a distance. The touch-sensitive surface of the sleeve consists of a grid of

  9. Postoperative changes in body composition after gastrectomy.

    Science.gov (United States)

    Kiyama, Teruo; Mizutani, Takashi; Okuda, Takeshi; Fujita, Itsuro; Tokunaga, Akira; Tajiri, Takashi; Barbul, Adrian

    2005-03-01

    Nutritional status is one of the most important clinical determinants of outcome after gastrectomy. The aim of this study was to compare changes in the body composition of patients undergoing laparoscopy-assisted gastrectomy (LAG), distal gastrectomy (DG), or total gastrectomy (TG). Total body protein and fat mass were measured by performing a multifrequency bioelectrical impedance analysis using an inBody II machine (Biospace, Tokyo, Japan) in 108 patients (72 men, 36 women) who had undergone LAG (n=24), DG (n=39), or TG (n=45). Changes between the preoperative data and results obtained on postoperative day 14 and 6 months after surgery were then evaluated. The mean preoperative body weight of the subjects was 57.6+/-10.7 kg, the mean body mass index was 22.5+/-3.4 kg/m(2), and the mean fat % was 24%+/-7%. In the immediate postoperative period (14 days), the body weight loss in the LAG group was significantly lower than in the DG and TG groups (2.5+/-0.9 kg vs. 3.5+/-1.8 kg and 4.0+/-1.9 kg, respectively; P < 0.0001). The body composition studies demonstrated a loss of total body protein rather than fat mass. Six months after surgery, body weight was not significantly different from preoperative values in the LAG and DG groups (-1.2+/-3.8 kg and -1.8+/-4.7 kg, respectively), but had decreased by 8.9+/-4.9 kg in the TG group (P=0.0003). A body composition analysis revealed a loss of fat mass in the DG and TG groups. The patients who underwent gastrectomy lost body protein mass during the early postoperative period. The type and extent of surgery has an effect on long-term body mass and composition. Bioelectric impedance analysis can be used to assess body composition and may be useful for nutritional assessment in patients who have undergone gastrectomy.

  10. Management of choledocholithiasis after previous gastrectomy.

    Science.gov (United States)

    Anwer, S; Egan, R; Cross, N; Guru Naidu, S; Somasekar, K

    2017-09-01

    Common bile duct stones in patients with a previous gastrectomy can be a technical challenge because of the altered anatomy. This paper presents the successful management of two such patients using non-traditional techniques as conventional endoscopic retrograde cholangiopancreatography was not possible.

  11. Food intake and nutritional status after gastrectomy

    DEFF Research Database (Denmark)

    Bisballe, S; Buus, S; Lund, B

    1986-01-01

    Food intake and nutritional status was studied in 67 patients, who had had a gastrectomy 2-30 years earlier, and in a randomly selected, matched group of healthy persons. The gastrectomized patients weighed less than the control persons (women 56.4 +/- 9.5 vs 61.4 +/- 6.9 kg; P less than 0.05; men...

  12. Management of Type 1 Late Sleeve Leak with Gastrobronchial Fistula by Laparoscopic Suturing and Conversion to Roux-en-Y Gastric Bypass: Video Report.

    Science.gov (United States)

    Praveenraj, Palanivelu; Gomes, Rachel M; Kumar, Saravana; Senthilnathan, Palanisamy; Parthasarathi, Ramakrishnan; Rajapandian, Subbiah; Palanivelu, Chinnusamy

    2015-12-01

    Gastrobronchial fistula (GBF) is a rare but serious complication after laparoscopic sleeve gastrectomy (LSG). It commonly appears sometime after the primary LSG. (Alharbi Ann Thorac Med. 8(3):179-80, 2013; Albanopoulos et al. Surg Obes Relat Dis. 9(6):e97-9, 2013). Surgical approach is an effective treatment. (Rebibo et al. Surg Obes Relat Dis. 10(3):460-67, 2014). The aim of this video was to demonstrate the operative management of a gastrobronchial fistula after LSG by laparoscopic suturing and conversion to a Roux-en-Y gastric bypass (RYGB). We present the case of a 53-year-old woman, with a BMI of 50.2 who presented with a left lower lobe consolidation 7 months after LSG. Imaging revealed a gastrobronchial fistula with left lower lobe consolidation and small sub-diaphragmatic collections. Endoscopy done revealed a fistulous opening beyond the oesophago-gastric junction and a trial of endoscopic stenting failed. In this multimedia high definition video, we present step-by-step the operative management of a late sleeve leak with gastrobronchial fistula by laparoscopic suturing and conversion to a RYGB. The procedure included mobilization of the gastric sleeve, identification and suturing of the fistulous opening, creation of a gastric pouch, creation of an ante-colic Roux limb, gastro-jejunal anastomosis and jejuno-jejunal anastomosis. Drainage of the fistula decreased with absence of a leak on imaging and pneumonia resolved in 15 days. This patient was diagnosed 7 months postoperatively with a gastric sleeve leak and the time to fistula closure from diagnosis was 2 months. GBF is a severe complication of bariatric surgery that usually presents late in the postoperative period. GBF after LSG can be treated by surgical fistula repair and conversion of the sleeve into a RYGB.

  13. Management of a jejunal obstruction caused by the migration of a laparoscopic adjustable gastric banding. A case report

    Directory of Open Access Journals (Sweden)

    Julien Lemaire

    2017-01-01

    Conclusion: Small bowel obstruction caused by LAGB migration is a rare but serious complication following IGM. In such cases, endoscopy has to be avoided because of the risk of jejunal disruption. The only way to treat it properly is surgery. This type of late complication reinforces the interest in the techniques currently used in bariatric surgery such as sleeve gastrectomy and gastric bypass, providing also a better weight loss than the LAGB.

  14. Performance of Grouted Splice Sleeve Connector under Tensile Load

    Directory of Open Access Journals (Sweden)

    A. Alias

    2016-05-01

    Full Text Available The grouted splice sleeve connector system takes advantage of the bond-slip resistance of the grout and the mechanical gripping of reinforcement bars to provide resistance to tensile force. In this system, grout acts as a load-transferring medium and bonding material between the bars and sleeve. This study adopted the end-to-end rebars connection method to investigate the effect of development length and sleeve diameter on the bonding performance of the sleeve connector. The end-to-end method refers to the condition where reinforcement bars are inserted into the sleeve from both ends and meet at the centre before grout is filled. Eight specimens of grouted splice sleeve connector were tested under tensile load to determine their performance. The sleeve connector was designed using 5 mm thick circular hollow section (CHS steel pipe and consisted of one external and two internal sleeves. The tensile test results show that connectors with a smaller external and internal sleeve diameter appear to provide better bonding performance. Three types of failure were observed in this research, which are bar fracture (outside the sleeve, bar pullout, and internal sleeve pullout. With reference to these failure types, the development length of 200 mm is the optimum value due to its bar fracture type, which indicates that the tensile capacity of the connector is higher than the reinforcement bar. It is found that the performance of the grouted splice sleeve connector is influenced by the development length of the reinforcement bar and the diameter of the sleeve.

  15. [Pneumonectomy: an alternative to sleeve resection in lung cancer patients?].

    Science.gov (United States)

    Schirren, J; Schirren, M; Passalacqua, M; Bölükbas, S

    2013-06-01

    Lung cancer is localized in the upper lobes in more than half of the cases. The risk of tumor infiltration of centrally located structures, such as bronchi and vessels are enhanced due to the anatomic topography. Pneumonectomy competes with sleeve resection for the surgical resection of centrally located tumors. The present review deals with the question if pneumonectomy should be considered as an alternative to sleeve resection for the treatment of lung cancer. Primary pneumonectomy does not provide any advantage even in advanced nodal disease. Extended lymph node dissection is not a contraindication for sleeve resections. Local recurrence rate is lower after sleeve resections despite the same radicality for both surgical treatment options. Mortality and morbidity rates are significantly lower for sleeve resections. Sleeve resections are associated with prolonged survival and better quality of life even in elderly patients.

  16. Effect of Previous Gastrectomy on the Performance of Postoperative Colonoscopy

    Science.gov (United States)

    Kim, Sunghwan; Choi, Jeongmin; Kim, Tae Han; Suh, Yun-Suhk; Im, Jong Pil; Lee, Hyuk-Joon; Kim, Sang Gyun; Jeong, Seung-Yong; Kim, Joo Sung; Yang, Han-Kwang

    2016-01-01

    Purpose The purpose of this study was to determine the effect of a prior gastrectomy on the difficulty of subsequent colonoscopy, and to identify the surgical factors related to difficult colonoscopies. Materials and Methods Patients with a prior gastrectomy who had undergone a colonoscopy between 2011 and 2014 (n=482) were matched (1:6) to patients with no history of gastrectomy (n=2,892). Cecal insertion time, intubation failure, and bowel clearance score were compared between the gastrectomy and control groups, as was a newly generated comprehensive parameter for a difficult/incomplete colonoscopy (cecal intubation failure, cecal insertion time >12.9 minutes, or very poor bowel preparation scale). Surgical factors including surgical approach, extent of gastrectomy, extent of lymph node dissection, and reconstruction type, were analyzed to identify risk factors for colonoscopy performance. Results A history of gastrectomy was associated with prolonged cecal insertion time (8.7±6.4 vs. 9.7±6.5 minutes; P=0.002), an increased intubation failure rate (0.1% vs. 1.9%; P<0.001), and a poor bowel preparation rate (24.7 vs. 29.0; P=0.047). Age and total gastrectomy (vs. partial gastrectomy) were found to be independent risk factors for increased insertion time, which slowly increased throughout the postoperative duration (0.35 min/yr). Total gastrectomy was the only independent risk factor for the comprehensive parameter of difficult/incomplete colonoscopy. Conclusions History of gastrectomy is related to difficult/incomplete colonoscopy performance, especially in cases of total gastrectomy. In any case, it may be that a pre-operative colonoscopy is desirable in selected patients scheduled for gastrectomy; however, it should be performed by an expert endoscopist each time. PMID:27752394

  17. Correlation of myelographic root sleeve deformity, uncovertebral spondylosis and radiculopathy

    Energy Technology Data Exchange (ETDEWEB)

    Nakstad, P.; Sortland, O.; Wiberg, J.

    1985-07-01

    Myelographic root sleeve deformities, uncovertebral spondylosis and myelopathy were correlated in 56 patients. Good correlation between root sleeve deformities and uncovertebral spondylosis was found. However, in some cases with spinal canal stenosis root sleeve deformities were found without corresponding bone changes. The correlation of radiculopathy to root sleeve deformity and uncovertebral spondylosis was 62 and 67%, respectively. Radiologic changes at an adjacent root level were often seen in patients without clinically correlated radiculopathy. The myelographic changes were verified at operation in all the 46 patients operated upon.

  18. Reconstruction of the esophagojejunostomy by double stapling method using EEA™ OrVil™ in laparoscopic total gastrectomy and proximal gastrectomy

    OpenAIRE

    Hirahara, Noriyuki; Monma, Hiroyuki; Shimojo, Yoshihide; Matsubara, Takeshi; Hyakudomi, Ryoji; Yano, Seiji; Tanaka, Tsuneo

    2011-01-01

    Abstract Here we report the method of anastomosis based on double stapling technique (hereinafter, DST) using a trans-oral anvil delivery system (EEATM OrVilTM) for reconstructing the esophagus and lifted jejunum following laparoscopic total gastrectomy or proximal gastric resection. As a basic technique, laparoscopic total gastrectomy employed Roux-en-Y reconstruction, laparoscopic proximal gastrectomy employed double tract reconstruction, and end-to-side anastomosis was used for the cut-off...

  19. LAPAROSCOPIC GASTRECTOMY WITH LONGMIRE’S PROCEDURE

    Directory of Open Access Journals (Sweden)

    R. A. Zubkov

    2016-01-01

    Full Text Available The arm of the research. To develop a way to perform the laparoscopic total gastrectomy with jejunal interposition (Longmire’s procedure.Material and methods. The study presents the technology of laparoscopic total gastrectomy with a lymph node dissection D1α and jejunal interposition. After removal of the gaster with the tumor through a mini-laparotomy (2 inch, the jejunum was cut approximately45 cm distally to the ligament of Treitz. A circular stapler was used to perform an esophago-jejunostomy with Roux-en-Y reconstruction using a standard technology. The second stage is forming a segment of the small intestine for jejunal interposition. The third stage is entering the head of the circular stapling apparatus into the stump of the duodenum on a probe retrogradely through the afferent loop of the small intestine. The fourth stage is stapled anastomosis between a free segment of the jejunum and the duodenum with the circular stapler. The procedure is finalized with hand-sewn anastomosis between the afferent and efferent loops of the small intestine.Results. The presented technology was used to perform surgery on one patient. The increase in operative time did not lead to increased intraoperative blood loss and longer post-operative bed-days. After 1 year the patient shows no evidence of a tumor progression, manifestations of reflux esophagitis, and dumping syndrome. Conclusion. The proposed technology allows laparoscopic total gastrectomy with jejunal interposition via a mini-invasive technology. 

  20. Emergency total gastrectomy for massive haemorrhage in a low ...

    African Journals Online (AJOL)

    Five (5) patients out of these had emergency total gastrectomy for uncontrollable bleeding proximal ulcer cancer. All the cases were males with the mean age of 64.6years. A total gastrectomy with a D2 lymph node dissection and a Roux-en-Y oesophago-jejunostomy was carried out. A splenectomy was done in cases when ...

  1. Early Results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS)

    Science.gov (United States)

    Peterli, Ralph; Borbély, Yves; Kern, Beatrice; Gass, Markus; Peters, Thomas; Thurnheer, Martin; Schultes, Bernd; Laederach, Kurt; Bueter, Marco; Schiesser, Marc

    2013-01-01

    Objective: Laparoscopic sleeve gastrectomy (LSG) has been proposed as an effective alternative to the current standard procedure, laparoscopic Roux-en-Y gastric bypass (LRYGB). Prospective data comparing both procedures are rare. Therefore, we performed a randomized clinical trial assessing the effectiveness and safety of these 2 operative techniques. Methods: Two hundred seventeen patients were randomized at 4 bariatric centers in Switzerland. One hundred seven patients underwent LSG using a 35-F bougie with suturing of the stapler line, and 110 patients underwent LRYGB with a 150-cm antecolic alimentary and a 50-cm biliopancreatic limb. The mean body mass index of all patients was 44 ± 11.1 kg/m2, the mean age was 43 ± 5.3 years, and 72% were female. Results: The 2 groups were similar in terms of body mass index, age, sex, comorbidities, and eating behavior. The mean operative time was less for LSG than for LRYGB (87 ± 52.3 minutes vs 108 ± 42.3 minutes; P = 0.003). The conversion rate was 0.9% in both groups. Complications (surgery. Long-term follow-up data are needed to confirm these facts. PMID:23989054

  2. Compliant sleeve for ceramic turbine blades

    Science.gov (United States)

    Cai, Hongda; Narasimhan, Dave; Strangman, Thomas E.; Easley, Michael L.; Schenk, Bjoern

    2000-01-01

    A compliant sleeve for attaching a ceramic member to a metal member is comprised of a superalloy substrate having a metal contacting side and a ceramic contacting side. The ceramic contacting side is plated with a layer of nickel followed by a layer of platinum. The substrate is then oxidized to form nickel oxide scale on the ceramic contacting side and a cobalt oxide scale on the metal contacting side. A lubricious coating of boron nitride is then applied over the metal contacting side, and a shear-stress limiting gold coating is applied over the ceramic contacting side.

  3. Hydrocarbon vapor diffusion in intact core sleeves

    International Nuclear Information System (INIS)

    Ostendorf, D.W.; Moyer, E.E.; Yuefeng Xie; Rajan, R.V.

    1993-01-01

    The diffusion of 2,2,4-trimethylpentane (TMP) and 2,2,5-trimethylhexane (TMH) vapors out of residually contaminated sandy soil from the US Environmental Protection Agency (EPA) field research site at Traverse City, Michigan, was measured and modeled. The headspace of an intact core sleeve sample was swept with nitrogen gas to simulate the diffusive release of hydrocarbon vapors from residual aviation gasoline in and immediately above the capillary fringe to a soil-venting air flow in the unsaturated zone. The resulting steady-state profile was modeled using existing diffusivity and air porosity estimates in a balance of diffusive flux and a first order source term. The source strength, which was calibrated with the observed flux of 2,2,4-TMP leaving the sleeve, varied with the residual gasoline remaining in the core, but was independent of the headspace sweep flow rate. This finding suggested that lower soil-venting air flow rates were in principle as effective as higher air flow rates in venting LNAPL vapors from contaminated soils. The saturated vapor concentration ratio of 2,2,4-TMP to 2,2,5-TMH decreased from 6.6 to 3.5 over the duration of the experiments in an expression of distillation effects. The vertical profile model was tested against sample port data in four separate experiments for both species, yielding mean errors ranging from 0 to -24% in magnitude

  4. Microfabricated sleeve devices for chemical reactions

    Science.gov (United States)

    Northrup, M. Allen

    2003-01-01

    A silicon-based sleeve type chemical reaction chamber that combines heaters, such as doped polysilicon for heating, and bulk silicon for convection cooling. The reaction chamber combines a critical ratio of silicon and non-silicon based materials to provide the thermal properties desired. For example, the chamber may combine a critical ratio of silicon and silicon nitride to the volume of material to be heated (e.g., a liquid) in order to provide uniform heating, yet low power requirements. The reaction chamber will also allow the introduction of a secondary tube (e.g., plastic) into the reaction sleeve that contains the reaction mixture thereby alleviating any potential materials incompatibility issues. The reaction chamber may be utilized in any chemical reaction system for synthesis or processing of organic, inorganic, or biochemical reactions, such as the polymerase chain reaction (PCR) and/or other DNA reactions, such as the ligase chain reaction, which are examples of a synthetic, thermal-cycling-based reaction. The reaction chamber may also be used in synthesis instruments, particularly those for DNA amplification and synthesis.

  5. Type A sleeve pipeline repair heated by induction

    Energy Technology Data Exchange (ETDEWEB)

    Souza, F.B.G. [Petrobras, Rio de Janeiro (Brazil). TransPetro; Meniconi, M.L.C. [Petrobras, Rio de Janeiro (Brazil). Centro de Pesquisas; Ghizoni, G. [JAMO Equipamentos LTDA, Jaragua do Sul (Brazil); Frainer, V.J.; Betanzos, J.T. [Univ. Federal do Rio Grande do Sul, Rio Grande (Brazil)

    2004-07-01

    Many pipeline operators routinely use full encirclement welded sleeves in their pipeline repair programs. Type A welded sleeves can be installed on a pipeline without the need for additional welding to the carrier pipe. This paper described a laboratory test conducted to measure the mechanical interference between a pipe and a type A welded sleeve that was applied using an induction heating method. Interference was evaluated through the use of strain gages installed after application of the sleeve over the pipe section. The induction heating equipment was used to pre-heat the steel tubes prior to primer epoxy application, as well as to obtain the heat-shrinkable anticorrosion coating. Induction heating took approximately 2 minutes. The sleeve was then cut longitudinally in diametric positions with an abrasive disc while signals were monitored by an automatic signal conditioner and a portable computer. Acquired data were plotted as a time versus deformation diagram. Results showed that the sleeve adhered well to the pipe. No bulging was detected. It was concluded that adequate machinery and assembling techniques are needed to ensure proper placement of the sleeve over the pipe as well as an even stress distribution. Future designs for induction coils should be developed to improve frequency rates. 8 refs., 7 figs.

  6. Sleeve type repair of degraded nuclear steam generator tubes

    International Nuclear Information System (INIS)

    Ayres, P.S.; Stark, L.E.; Feldstein, J.G.; Fu, T.

    1986-01-01

    A sealable sleeve is described for insertion into the repair of a degraded tube which consists of: a hollow core inner member of the same material as the degraded tube; a thinner outer member of substantially pure nickel and resistant to corrosive attack, the outer member being metallurgically bonded with the inner member; an expanded portion of the sleeve at one end for positioning in the tube within a tube sheet; a multiplicity of grooves formed in and adjacent to the other end of the sleeve which extends into the free-standing portion of the tube beyond the tube sheet, and a noble metal braze material contained in the grooves

  7. Laparoscopic sleeve gastrectomy using a synthetic bioabsorbable staple line reinforcement material: Post-operative complications and 6 year outcomes

    Directory of Open Access Journals (Sweden)

    Mahdi Saleh

    2016-09-01

    Conclusion: The synthetic bioabsorbable reinforcement material shows no staple line leaks making it safe to use. LSG as a procedure had a high resolution of obesity-related comorbidities as well as sustainable long-term weight loss.

  8. Endoscopic Sleeve Gastroplasty - A New Tool to Manage Obesity

    OpenAIRE

    Jain, Deepanshu; Bhandari, Bharat Singh; Arora, Ankit; Singhal, Shashideep

    2017-01-01

    Obesity is a growing pandemic across the world. Dietary restrictions and behavior modifications alone have a limited benefit. Bariatric surgery, despite being the current gold standard, has limited acceptance by patients due to cost and associated morbidity. In our review, we have discussed nine original studies describing endoscopic sleeve gastroplasty (ESG). A total of 172 subjects successfully underwent ESG. Of 65 subjects with follow up data, 95.4% (62/65) had intact gastric sleeve confir...

  9. Dual-port distal gastrectomy for the early gastric cancer

    OpenAIRE

    Kashiwagi, Hiroyuki; Kumagai, Kenta; Monma, Eiji; Nozue, Mutsumi

    2014-01-01

    Background Although recent trends in laparoscopic procedures have been toward minimizing the number of incisions, four or five ports are normally required to complete laparoscopic gastrectomy because of the complexity of this procedure. Multi-channel ports, such as the SILS port (Covidien, JAPAN), are now available and are crucial for performing single-incision laparoscopic surgery (SILS) or reduced port surgery (RPS). We carried out reduced port distal gastrectomy (RPDG) using a dual-port me...

  10. Experimental study on Bond slip relationship of Steel sleeve

    Directory of Open Access Journals (Sweden)

    Wang J.C.

    2016-01-01

    Full Text Available The assembled concrete structure is usually connected with the steel bar through the sleeve. In order to realize the optimum design of sleeve structure and develop new sleeve, the author put forward a new test method, and made 18 specimens for uniaxial tensile test. Study the influence of the strength of grouting material, diameter of reinforcing steel bar on bond slip relationship between steel bar and grouting material and its failure characteristics by experimental research. This result suggests that with the increase of age, the bond strength between steel bar and grouting material is increasing gradually, the increase speed gradually slowed down after 20 days. For CT20H sleeve, with the increase of the diameter of reinforcement, the bond strength between reinforcement and grouting material increased gradually. Conclusion: In the optimization design of the sleeve, under the premise of ensuring the smooth injection of grouting material and be convenient for the positioning of the reinforced members, reducing the inner diameter of the sleeve can improve the bond strength between reinforcement and grouting material.

  11. Food intake and nutritional status after gastrectomy

    DEFF Research Database (Denmark)

    Bisballe, S; Buus, S; Lund, B

    1986-01-01

    Food intake and nutritional status was studied in 67 patients, who had had a gastrectomy 2-30 years earlier, and in a randomly selected, matched group of healthy persons. The gastrectomized patients weighed less than the control persons (women 56.4 +/- 9.5 vs 61.4 +/- 6.9 kg; P less than 0.05; men.......01). The serum concentration of alkaline phosphatase was raised and the concentration of calcium, phosphorus and 25-hydroxycholecalciferol reduced in the gastrectomized group. None of these results could be explained from the nutritional study as both the intake of energy and protein and the intake of calcium...... normal serum values. As the serum level of 25-hydroxycholecalciferol is correlated to the degree of osteomalacia, all gastrectomized patients should have at least 10 micrograms vitamin D as a supplement once a day....

  12. [Risk factors of cholecystitis after radical gastrectomy for gastric cancer].

    Science.gov (United States)

    Guo, Tuankui; Yang, Liqing; Liu, Yun; Tian, Qinggang; Wang, Xiaona; Li, Bin; Hou, Yachao; Liu, Hongmin; Liang, Han

    2016-04-01

    To investigate the risk factor of cholecystitis after radical gastrectomy for gastric cancer. Clinicpathological data of 553 gastric cancer patients with normal gallbladders undergoing radical gastrectomy in Tianjin Medical University Cancer Institute and Hospital between March 2013 and March 2015 were analyzed retrospectively. Univariate and multivariate analysis were applied to evaluate factors influencing the cholecystitis after radical gastrectomy using log-rank and logistic regression model. There were 360 males and 193 females with a median age of 60 years. All patients were followed up from 6 months to 2 years. The incidence of cholecystitis after radical gastrectomy for gastric cancer was 33.1%(183/553), while incidence of cholecystolithiasis was 4.9%(27/553). In addition, the cholecystitis incidence of patients with No.12 lymph node cleaning was 39.6%(89/225), while with No.8a lymph node cleaning was 38.0%(151/397), with No.5 lymph node cleaning was 38.0%(68/179), with No.7 lymph node cleaning was 34.4%(138/402), with No.9 lymph node cleaning was 34.7%(136/392). Univariate log-rank test indicated that the lymphadenectomy of No.8a(χ(2)=15.530, P=0.000), No.12 group(χ(2)=7.157, P=0.007) and surgical methods (χ(2)=7.427, P=0.024) were significantly associated with cholecystitis after radical gastrectomy. Multivariate analysis showed that the lymphadenectomy of No.8a was independent factor of cholecystitis after radical gastrectomy (OR=2.016, 95% CI:1.244 to 3.267, P=0.004). Vagal nerve trunk and sympathetic ganglion should be protected carefully during No.8a lymphadenectomy in radical gastrectomy for gastric cancer, in order to reduce the incidence of postoperative cholecystitis.

  13. Robot-assisted gastrectomy and oesophagectomy for cancer.

    Science.gov (United States)

    Falkenback, Dan; Lehane, Christopher W; Lord, Reginald V N

    2014-10-01

    Robot-assisted surgery is a technically feasible alternative to open and laparoscopic surgery, which is being more frequently used in general surgery. We undertook this review to investigate whether robotic assistance provides a significant benefit for oesophagogastric cancer surgery. Electronic databases were searched for original English-language publications for robotic-assisted gastrectomy and oesophagectomy between January 1990 and October 2013. Sixty-one publications were included. Thirty-five included gastrectomy, 31 included oesophagectomy and five included both operations. Several publications suggest that robot-assisted subtotal gastrectomy can be as safe and effective as an open or laparoscopic procedure, with equal outcomes with regard to the number of lymph nodes resected, overall morbidity and perioperative mortality, and length of hospital stay. Robotic assistance is associated with longer operation times but also with less blood loss in some reports. A significant benefit for robotic assistance has not been shown for the more extensive operations of oesophagectomy or total gastrectomy with D2-lymphadenectomy. There are very few oncologic data regarding local recurrence or long-term survival for any of the robotic operations. No significant differences in morbidity, mortality or number of lymph node harvested have been shown between robot-assisted and laparoscopic gastrectomy or oesophagectomy. Robotic surgery, with its relatively short learning curve, may facilitate reproducible minimally invasive surgery in this field but operation times are reportedly longer and cost differences remain unclear. Randomized trials with oncologic outcomes and cost comparisons are needed. © 2014 Royal Australasian College of Surgeons.

  14. Endoscopic sleeve gastroplasty: the learning curve.

    Science.gov (United States)

    Hill, Christine; El Zein, Mohamad; Agnihotri, Abhishek; Dunlap, Margo; Chang, Angela; Agrawal, Alison; Barola, Sindhu; Ngamruengphong, Saowanee; Chen, Yen-I; Kalloo, Anthony N; Khashab, Mouen A; Kumbhari, Vivek

    2017-09-01

     Endoscopic sleeve gastroplasty (ESG) is gaining traction as a minimally invasive bariatric treatment. Concern that the learning curve may be slow, even among those proficient in endoscopic suturing, is a barrier to widespread implementation of the procedure. Therefore, we aimed to define the learning curve for ESG in a single endoscopist experienced in endoscopic suturing who participated in a 1-day ESG training program.  Consecutive patients who underwent ESG between February 2016 and November 2016 were included. The performing endoscopist, who is proficient in endoscopic suturing for non-ESG procedures, participated in a 1-day ESG training session before offering ESG to patients. The outcome measurements were length of procedure (LOP) and number of plications per procedure. Nonlinear regression was used to determine the learning plateau and calculate the learning rate.  Twenty-one consecutive patients (8 males), with mean age 47.7 ± 11.2 years and mean body mass index 41.8 ± 8.5 kg/m 2 underwent ESG. LOP decreased significantly across consecutive procedures, with a learning plateau at 101.5 minutes and a learning rate of 7 cases ( P  = 0.04). The number of plications per procedure also decreased significantly across consecutive procedures, with a plateau at 8 sutures and a learning rate of 9 cases ( P  < 0.001). Further, the average time per plication decreased significantly with consecutive procedures, reaching a plateau at 9 procedures ( P  < 0.001).  Endoscopists experienced in endoscopic suturing are expected to achieve a reduction in LOP and number of plications per procedure in successive cases, with progress plateauing at 7 and 9 cases, respectively.

  15. Endoscopic Sleeve Gastroplasty - A New Tool to Manage Obesity.

    Science.gov (United States)

    Jain, Deepanshu; Bhandari, Bharat Singh; Arora, Ankit; Singhal, Shashideep

    2017-11-01

    Obesity is a growing pandemic across the world. Dietary restrictions and behavior modifications alone have a limited benefit. Bariatric surgery, despite being the current gold standard, has limited acceptance by patients due to cost and associated morbidity. In our review, we have discussed nine original studies describing endoscopic sleeve gastroplasty (ESG). A total of 172 subjects successfully underwent ESG. Of 65 subjects with follow up data, 95.4% (62/65) had intact gastric sleeve confirmed via esophagogastroduodenoscopy or oral contrast study at the end of study specific follow up interval (the longest being 6 months). Individual studies reported a technical success rate for intact gastric sleeve from as low as 50% to as high as 100%. A statistically significant p ESG an attractive option to consider among other bariatric therapies.

  16. Sleeve Push Technique: A Novel Method of Space Gaining.

    Science.gov (United States)

    Verma, Sanjeev; Bhupali, Nameksh Raj; Gupta, Deepak Kumar; Singh, Sombir; Singh, Satinder Pal

    2018-01-01

    Space gaining is frequently required in orthodontics. Multiple loops were initially used for space gaining and alignment. The most common used mechanics for space gaining is the use of nickel-titanium open coil springs. The disadvantage of nickel-titanium coil spring is that they cannot be used until the arches are well aligned to receive the stiffer stainless steel wires. Therefore, a new method of gaining space during initial alignment and leveling has been developed and named as sleeve push technique (SPT). The nickel-titanium wires, i.e. 0.012 inches and 0.014 inches along with archwire sleeve (protective tubing) can be used in a modified way to gain space along with alignment. This method helps in gaining space right from day 1 of treatment. The archwire sleeve and nickel-titanium wire in this new SPT act as a mutually synergistic combination and provide the orthodontist with a completely new technique for space opening.

  17. Self Touch to Touch Others: Designing the Tactile Sleeve for Social Touch

    NARCIS (Netherlands)

    Huisman, G.; Darriba Frederiks, A.; van Dijk, B.; Kröse, B.; Heylen, D.

    2013-01-01

    In this paper we present the concept and initial design stages of the TaSST (Tactile Sleeve for Social Touch). The TaSST consists of a soft pressure-sensitive input layer, and an output layer containing vibration motors. A touch to ones own sleeve is felt as a vibration on the sleeve of another

  18. Self touch to touch others : designing the tactile sleeve for social touch

    NARCIS (Netherlands)

    Huisman, Gijs; Darriba Frederiks, Aduén; Heylen, Dirk; Van Dijk, Betsy; Kröse, Ben

    2013-01-01

    In this paper we present the concept and initial design stages of the TaSST (Tactile Sleeve for Social Touch). The TaSST consists of a soft pressure-sensitive input layer, and an output layer containing vibration motors. A touch to ones own sleeve is felt as a vibration on the sleeve of another

  19. AN INVESTIGATION OF FASHION DESIGN AND PATTERN MAKING OF LADIES' JACKETS WITH DIFFERENT TYPES OF SLEEVES

    Directory of Open Access Journals (Sweden)

    Zlatina Kazlacheva

    2016-12-01

    Full Text Available The patterns of raglan, semi raglan, kimono, and dropped shoulder sleeves are made on one and the same constructional bases. In the constructional base the front and back in the underarm there are parts which have to be set to the both - the bodice and the sleeve. For the front and the back that is possible if the sleeve and a part of the bodice are separated by a design constructional seam. The type and design of the sleeve depends by the directions of the design constructional seam. If the seam joins the underarm and the neckline, or area around the neckline the type of sleeve is raglan. If the seam connects the underarm and the shoulder the type of sleeve is semi raglan. The type of the sleeve is kimono if the design constructional seam divides the bodice or the sleeve. In the dropped shoulder sleeve design constructional seam is located under the shoulder. The use of the main design principles, the possibilities for combinations between the four types of sleeves and the design with application of 3D elements are investigated. Raglan, semi raglan, kimono and dropped shoulder sleeves can be combined each other. In combined sleeves only one of seams which define the types of the sleeves is with decorative constructional function. The other ones have only decorative function. Design constructional seams which define the types of the sleeves can be used as contours of location or fixation of all types of 3D elements: pleats, goffers, flounces, tucks gathers, and draperies. The results of the investigation of application of the main design principles, combinations between different types of sleeves and possibility for the use of 3D elements facilitate the process of fashion design and pattern making and gives opportunity for variety of models.

  20. Development of 100MW Gas Turbine Shaft Sleeve Puller | Sadjere ...

    African Journals Online (AJOL)

    A Shaft Sleeve Puller was developed, designed and constructed in response to the need to pull-out / pull-in the 30-tonnes by 12m long rotor of the 100-MW gas turbine generator for inspection, as part of a refurbishment programme of a power station in Delta State, Nigeria. The design is a runway system, consisting of a ...

  1. Sleeve Muscle Actuator and Its Application in Transtibial Prostheses

    Science.gov (United States)

    Zheng, Hao; Shen, Xiangrong

    2014-01-01

    This paper describes the concept of a new sleeve muscle actuator, and a transtibial prosthesis design powered by this novel actuator. Inspired by the functioning mechanism of the traditional pneumatic muscle actuator, the sleeve muscle actuator incorporates a cylindrical insert to the center of the pneumatic muscle, which eliminates the central portion of the internal volume. As a result of this change, the sleeve muscle provides multiple advantages over the traditional pneumatic muscle, including the increased force capacity over the entire range of motion, reduced energy consumption, and faster dynamic response. Furthermore, utilizing the load-bearing tube as the insert, the sleeve muscle enables an innovative “actuation-load bearing” structure, which has a potential of generating a highly compact actuation system suitable for prosthetic use. Utilizing this new actuator, the preliminary design of a transtibial prosthesis is presented, which is able to provide sufficient torque output and range of motion for a 75 Kg amputee user in level walking. PMID:24187262

  2. Retained copper sleeve of cu-T IUCD

    African Journals Online (AJOL)

    Dr Adaji

    Case Report. A 47-year old para 7+1 five alive presented at the. Reproductive Health center for removal of a copper-T intrauterine contraceptive device following a clinical diagnosis of pelvic inflammatory disease. The device was inserted the previous year. After easy removal , it was observed that the copper sleeve on one ...

  3. Modification of early postoperative X-ray research after gastrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Sapounov, S.

    1982-10-01

    A modification of the early postoperative X-ray research after gastrectomy is described. The application of gastrografin happens through a nasogastric tube. By changing the position of its tip during the screening control, and excellent and precise represention of the anastomotic region will be achieved. We present a research of 35 patients.

  4. Risk factors for postoperative pneumonia after gastrectomy for gastric cancer.

    Science.gov (United States)

    Miki, Yuichiro; Makuuchi, Rie; Tokunaga, Masanori; Tanizawa, Yutaka; Bando, Etsuro; Kawamura, Taiichi; Terashima, Masanori

    2016-05-01

    The number of elderly patients undergoing gastrectomy for gastric cancer is increasing. Yet, although elderly patients are at high risk of postoperative pneumonia, no study has sufficiently investigated which clinicopathological factors are significant risk factors for the development of this complication after gastrectomy with lymph node dissection. We reviewed the medical records of 750 patients who underwent gastrectomy between January 2010 and May 2012, to establish the incidence of postoperative pneumonia (Clavien-Dindo grade II or higher). Univariate and multivariate analyses were performed to identify the risk factors for postoperative pneumonia. Thirty-two patients (4.3 %) suffered postoperative pneumonia, diagnosed as grades I, II, IIIa, and IVa, in 2 (0.3 %), 28 (3.7 %), 1 (0.2 %), and 1 (0.2 %) patient(s), respectively. Univariate analysis revealed that age (≥75 years), sex (male), diabetes mellitus (DM), a history of smoking, and impairment of respiratory function were significantly associated with postoperative pneumonia. Multivariate analysis revealed that age, impaired postoperative respiratory function, DM, and blood transfusion were independent risk factors for postoperative pneumonia. Age, impaired postoperative respiratory function, DM, and blood transfusion were identified as independent risk factors for postoperative pneumonia after gastrectomy.

  5. Retrograde jejunal intussusception after total gastrectomy: A case ...

    African Journals Online (AJOL)

    Retrograde jejunal intussusception is a rare disease. A 60‑year‑old female patient was hospitalized due to vomiting for 2 days, with a history of radical gastrectomy plus esophagus jejunum Rouxs‑en‑Y. On examination, there was a palpable wax‑like mass on the left‑hand side underneath the umbilicus. Computerized ...

  6. Retrograde jejunal intussusception after total gastrectomy: A case ...

    African Journals Online (AJOL)

    2015-11-02

    Nov 2, 2015 ... Retrograde jejunal intussusception is a rare disease. A 60-year-old female patient was hospitalized due to vomiting for 2 days, with a history of radical gastrectomy plus esophagus jejunum Rouxs-en-Y. On examination, there was a palpable wax-like mass on the left-hand side underneath the umbilicus.

  7. Manometric and hormonal changes after distal partial gastrectomy.

    Science.gov (United States)

    Yamashita, Y; Inoue, H; Ohta, K; Yoshida, K; Miyahara, E; Hirai, T; Toge, T; Adrian, T E

    2000-04-01

    Alkaline oesophagitis attributable to duodenal mechanisms may induce oesophageal carcinogenesis in a rat reflux model. To investigate the mechanism of the regurgitation after distal partial gastrectomy. Oesophageal manometry was used in 16 patients before and after distal partial gastrectomy with reconstruction by Bilroth methods. Serum concentrations of four gastrointestinal hormones were measured by radioimmunoassay in 10 gastrectomy patients and nine healthy volunteers before and after a standardized meal. The lower oesophageal sphincter pressure was reduced to 83% after surgery. The amplitude and duration of the peristaltic waves tended to be increased, and the velocity tended to be less after surgery (amplitude 120%, duration 114%, velocity 88%). Interrupted waves appeared more frequently after surgery. The manometric changes in gastrectomized patients are considered to be disadvantageous relative to regurgitation. After surgery, gastrin and pancreatic polypeptide were completely abolished postprandially, whereas cholecystokinin and neurotensin were significantly increased. The hormonal changes should have a suppressive effect on the lower oesophageal sphincter. Both the manometric and the hormonal changes may exacerbate reflux oesophagitis after distal partial gastrectomy.

  8. [Function-preserving gastrectomy for early gastric cancer based on Japanese researches].

    Science.gov (United States)

    Zhang, Chi; Hu, Xiang

    2018-02-25

    In the past, people only focused on surgical resection of gastric cancer to obtain satisfactory therapeutic effect, while the concept of function-preserving in gastric cancer surgery has not been emphasized. Gastric function-preserving surgery was originally performed by Japanese doctor Maki for surgical treatment of gastroduodenal ulcer. With the definition of early gastric cancer being accepted, the pylorus-preserving gastrectomy can be used continuously in the treatment of gastric cancer. Because of high incidence of early gastric cancer in Japan, a variety of application and research about function-preserving gastrectomy in other areas for treatment of early gastric cancer, such as proximal gastrectomy and jejunal interposition, segmental gastrectomy, gastric local resection and laparoscopic and endoscopic cooperative surgery (LECS) at the same time, and regional or sentinel lymph node dissection were performed for the purpose of radical cure. Function-preserving gastrectomy for the treatment of early gastric cancer should include four important factors: (1) decrease of the scope of gastrectomy; (2)retaining pylorus; (3)retaining vagus nerve; (4)regional or sentinel lymph node dissection. The technique of sentinel lymph node can reduce the extent of gastric resection, avoid distal gastrectomy or total gastrectomy, and make gastric resection more suitable for laparoscopic partial gastrectomy, segmental resection, pylorus-preserving gastrectomy and proximal gastrectomy. Function-preserving gastrectomy has the advantage of improving the quality of life and has great potential in the treatment of early gastric cancer. However, the various treatment methods including LECS need strict technical standardization for confirmation of oncology safety. We need careful design, prospective multicenter randomized controlled trials to provide theoretical and technical support.

  9. Silicon-based sleeve devices for chemical reactions

    Science.gov (United States)

    Northrup, M. Allen; Mariella, Jr., Raymond P.; Carrano, Anthony V.; Balch, Joseph W.

    1996-01-01

    A silicon-based sleeve type chemical reaction chamber that combines heaters, such as doped polysilicon for heating, and bulk silicon for convection cooling. The reaction chamber combines a critical ratio of silicon and silicon nitride to the volume of material to be heated (e.g., a liquid) in order to provide uniform heating, yet low power requirements. The reaction chamber will also allow the introduction of a secondary tube (e.g., plastic) into the reaction sleeve that contains the reaction mixture thereby alleviating any potential materials incompatibility issues. The reaction chamber may be utilized in any chemical reaction system for synthesis or processing of organic, inorganic, or biochemical reactions, such as the polymerase chain reaction (PCR) and/or other DNA reactions, such as the ligase chain reaction, which are examples of a synthetic, thermal-cycling-based reaction. The reaction chamber may also be used in synthesis instruments, particularly those for DNA amplification and synthesis.

  10. Strategic laparoscopic surgery for improved cosmesis in general and bariatric surgery: analysis of initial 127 cases.

    Science.gov (United States)

    Nguyen, Ninh T; Smith, Brian R; Reavis, Kevin M; Nguyen, Xuan-Mai T; Nguyen, Brian; Stamos, Michael J

    2012-05-01

    Strategic laparoscopic surgery for improved cosmesis (SLIC) is a less invasive surgical approach than conventional laparoscopic surgery. The aim of this study was to examine the feasibility and safety of SLIC for general and bariatric surgical operations. Additionally, we compared the outcomes of laparoscopic sleeve gastrectomy with those performed by the SLIC technique. In an academic medical center, from April 2008 to December 2010, 127 patients underwent SLIC procedures: 38 SLIC cholecystectomy, 56 SLIC gastric banding, 26 SLIC sleeve gastrectomy, 1 SLIC gastrojejunostomy, and 6 SLIC appendectomy. SLIC sleeve gastrectomy was initially performed through a single 4.0-cm supraumbilical incision with extraction of the gastric specimen through the same incision. The technique evolved to laparoscopic incisions that were all placed within the umbilicus and suprapubic region. There were no 30-day or in-hospital mortalities or 30-day re-admissions or re-operations. For SLIC cholecystectomy, gastric banding, appendectomy, and gastrojejunostomy, conversion to conventional laparoscopy occurred in 5.3%, 5.4%, 0%, and 0%, respectively; there were no major or minor postoperative complications. For SLIC sleeve gastrectomy, there were no significant differences in mean operative time and length of hospital stay compared with laparoscopic sleeve gastrectomy; 1 (3.8%) of 26 SLIC patients required conversion to five-port laparoscopy. There were no major complications. Minor complications occurred in 7.7% in the SLIC sleeve group versus 8.3% in the laparoscopic sleeve group. SLIC in general and bariatric operations is technically feasible, safe, and associated with a low rate of conversion to conventional laparoscopy. Compared with laparoscopic sleeve gastrectomy, SLIC sleeve gastrectomy can be performed without a prolonged operative time with comparable perioperative outcomes.

  11. DEVELOPMENT OF PERMANENT MECHANICAL REPAIR SLEEVE FOR PLASTIC PIPE

    Energy Technology Data Exchange (ETDEWEB)

    Hitesh Patadia

    2004-09-30

    The report presents a comprehensive summary of the project status related to the development of a permanent mechanical repair fitting intended to be installed on damaged PE mains under blowing gas conditions. Specifically, the product definition has been developed taking into account relevant codes and standards and industry input. A conceptual design for the mechanical repair sleeve has been developed which meets the product definition.

  12. Sleeve resection for delayed presentation of traumatic bronchial transection.

    LENUS (Irish Health Repository)

    Mohamed, H Y

    2010-02-01

    Tracheobronchial disruption is uncommon in blunt chest trauma. Many of these patients die before reaching the hospital. In the majority of survivors diagnosis is occasionally delayed resulting in complications like airway stenosis and lung collapse. Thus it is important to have radiological follow up after severe thoracic trauma. Sleeve resection can be an excellent option to conserve lung tissue in delayed presentation of bronchial transection.

  13. Posterior labrocapsular periosteal sleeve avulsion complicating locked posterior shoulder dislocation

    Energy Technology Data Exchange (ETDEWEB)

    Simons, P. [Department of Radiology, Onze Lieve Vrouwe Hospital, Aalst (Belgium)]|[Department of Radiology, Leiden University Medical Centre, Leiden (Netherlands); Joekes, E.; Bloem, J.L. [Department of Radiology, Leiden University Medical Centre, Leiden (Netherlands); Nelissen, R.G.H.H. [Department of Orthopaedic Surgery, Leiden University Medical Centre (Netherlands)

    1998-10-01

    This case presents the imaging features of a posterior shoulder dislocation complicated by a rare but surgically relevant lesion of the posterior labrum. Due to the attachment of the posterior capsule to the posterior portion of the labrum, which in itself is attached to the posterior scapular periosteum, stripping of the labrum by the posterior capsule resulted in a posterior labrocapsular periosteal sleeve avulsion. (orig.) With 4 figs., 5 refs.

  14. Sleeve push technique: A novel method of space gaining

    Directory of Open Access Journals (Sweden)

    Sanjeev Verma

    2018-01-01

    Full Text Available Space gaining is frequently required in orthodontics. Multiple loops were initially used for space gaining and alignment. The most common used mechanics for space gaining is the use of nickel–titanium open coil springs. The disadvantage of nickel–titanium coil spring is that they cannot be used until the arches are well aligned to receive the stiffer stainless steel wires. Therefore, a new method of gaining space during initial alignment and leveling has been developed and named as sleeve push technique (SPT. The nickel–titanium wires, i.e. 0.012 inches and 0.014 inches along with archwire sleeve (protective tubing can be used in a modified way to gain space along with alignment. This method helps in gaining space right from day 1 of treatment. The archwire sleeve and nickel–titanium wire in this new SPT act as a mutually synergistic combination and provide the orthodontist with a completely new technique for space opening.

  15. Elastic Knee Sleeves Limit Anterior Tibial Translation in Healthy Females

    Directory of Open Access Journals (Sweden)

    Robert Csapo, Simona Hosp, Ramona Folie, Robert Eberle, Michael Hasler, Werner Nachbauer

    2016-03-01

    Full Text Available Knee sleeves or braces represent auxiliary tools that have repeatedly been used by athletes, in an attempt to increase knee stability and, thus, reduce the risk of (recurrent ligamentous injuries. Since ACL injuries typically occur in situations involving either torsion or hyperextension of the knee, it has been speculated that braces might protect the ACL by countering excessive anterior translation of the tibia with respect to the femur (Beynnon et al., 1997. However, the preponderance of in vivo studies to test this hypothesis was performed in cohorts of patients suffering from existent ligamentous (Branch et al., 1988; Colville et al., 1986 or other knee injury (Beynnon et al., 1997; Fleming et al., 2000. This complicates the extrapolation of results to healthy subjects. Further, the braces used in these studies were mostly rigid constructs that consisted of either uni- or bilateral hinged bars (Rishiraj et al., 2009. Such braces might hinder performance (Veldhuizen et al., 1991 and would be rejected by the vast majority of healthy athletes. For these reasons, we would like to use this letter to the editor to report the results of our experiments investigating whether a relatively light elastic knee sleeve would limit the degree of anterior tibial translation in computerized arthrometry tests as performed in a sample of non-injured subjects. We recruited ten female college students (age: 23.4 ± 3.2 yrs, height: 1.68 ± 0.05 m, mass: 59.9 ± 5.5 kg who were free of acute or previous injury or any form of orthopaedic disease of the knee joints. The anterior displacement of the tibia was measured using the GNRB® computerized arthrometer (GeNouRob, Laval, France. With subjects lying in the supine position, the lower leg was firmly fixed with plastic caps mounted over the ankle joint and patella. An electrical pressure pad then exerted increasing pressure of up to 250 N on the calf, while a motion sensor, which was positioned on the ventral

  16. Effects of wearing lower leg compression sleeves on locomotion economy.

    Science.gov (United States)

    Kurz, Eduard; Anders, Christoph

    2018-02-15

    The purpose of this investigation was to assess the effect of compression sleeves on muscle activation cost during locomotion. Twenty-two recreationally active men (age: 25 ± 3 years) ran on a treadmill at four different speeds (ordered sequence of 2.8, 3.3, 2.2, and 3.9 m/s). The tests were performed without (control situation, CON) and while wearing specially designed lower leg compression sleeves (SL). Myoelectric activity of five lower leg muscles (tibialis anterior, fibularis longus, lateral and medial head of gastrocnemius, and soleus) was captured using Surface EMG. To assess muscle activation cost, the cumulative muscle activity per distance travelled (CMAPD) of the CON and SL situations was determined. Repeated measures analyses of variance were performed separately for each muscle. The analyses revealed a reduced lower leg muscle activation cost with respect to test situation for SL for all muscles (p  0.18). The respective significant reductions of CMAPD values during SL ranged between 4% and 16% and were largest at 2.8 m/s. The findings presented point towards an improved muscle activation cost while wearing lower leg compression sleeves during locomotion that have potential to postpone muscle fatigue.

  17. Crimped braided sleeves for soft, actuating arm in robotic abdominal surgery

    OpenAIRE

    Elsayed, Y; Lekakou, Constantina; Ranzani, T; Cianchetti, M; Morino, M; Arezzo, A; Menciassi, A; Geng, T; Saaj, Chakravarthini; Chirurgia, M

    2015-01-01

    Background: This paper investigates different types of crimped, braided sleeve used for a soft arm for robotic abdominal surgery, with the sleeve required to contain balloon expansion in the pneumatically actuating arm while it follows the required bending, elongation and diameter reduction of the arm. Material and methods: Three types of crimped, braided sleeves from PET (BraidPET) or nylon (BraidGreyNylon and BraidNylon, with different monofilament diameters) were fabricated and tested incl...

  18. Totally Laparoscopic Gastrectomy for Gastric Cancer Associated with Recklinghausen's Disease

    Directory of Open Access Journals (Sweden)

    Yoshihisa Sakaguchi

    2010-01-01

    Full Text Available This paper documents the first case of gastric cancer associated with Recklinghausen's disease, which was successfully treated by a totally laparoscopic operation. A 67-year-old woman with Recklinghausen's disease was referred to this department to undergo surgical treatment for early gastric cancer. The physical examination showed multiple cutaneous neurofibromas throughout the body surface, which made an upper abdominal incision impossible. Laparoscopic surgery requiring only small incisions was well indicated, and a totally laparoscopic distal gastrectomy with lymph node dissection was performed. Billroth I reconstruction was done intra-abdominally using a delta-shaped anastomosis. The patient followed a satisfactory postoperative course with no complications. Since the totally laparoscopic gastrectomy has many advantages over open surgery, it should therefore be preferentially used as a less invasive treatment in the field of gastric cancer.

  19. Prophylactic total gastrectomy in hereditary diffuse gastric cancer

    DEFF Research Database (Denmark)

    Bardram, Linda; Hansen, Thomas V O; Gerdes, Anne-Marie

    2014-01-01

    and found pathogenic. In silico and mini-gene assay were used to predict the functional consequence in one of them. Mutation carriers were offered endoscopy and total gastrectomy. The gastric specimens were completely sectioned and examined histologically. Seven asymptomatic mutation carriers were operated......Inactivating mutations in the CDH1 (E-cadherin) gene are the predisposing cause of gastric cancer in most families with hereditary diffuse gastric cancer (HDGC). The lifetime risk of cancer in mutation positive members is more than 80 % and prophylactic total gastrectomy is recommended. Not all...... mutations in the CDH1 gene are however pathogenic and it is important to classify mutations before this major operation is performed. Probands from two Danish families with gastric cancer and a history suggesting HDGC were screened for CDH1 gene mutations. Two novel CDH1 gene mutations were identified...

  20. [Patients with gastric cancer submitted to gastrectomy: an integrative review].

    Science.gov (United States)

    Mello, Bruna Schroeder; Lucena, Amália de Fátima; Echer, Isabel Cristina; Luzia, Melissa de Freitas

    2010-12-01

    This study aims to analyze the scientific production about patients with gastric cancer submitted to gastrectomy and describe important aspects of nursing guidelines for these patients. An integrative review was carried out using Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Medical Literature Analysis and Retrieval System Online (MEDLINE) databases; twenty two articles were analyzed. Retrospective cross-sectional studies were the most frequent. The scientific production of nursing is numerically small in relation to the medical area. The results show that approaches related to pre and post-operative in gastrectomy for gastric cancer resection subsidize the knowledge of issues essential for nurses to promote efficient intervention for the recovery of such patients. There is still the need for further research on the practice of nursing in the guidelines of this kind of surgery.

  1. [Causes of malnutrition in post-gastrectomy patient].

    Science.gov (United States)

    Papini-Berto, S J; Burini, R C

    2001-01-01

    The stomach through its mechanical and chemical processes has an unique role in the food processing and bioavailability. Hence gastrectomy has predictable and modifiable nutritional consequences depending upon its knowledge and the post-surgery therapies. To point out the impact of gastrectomy on the nutritional status focusing on both mechanical and chemical actions of stomach on intaked foods. The protein-energy malnutrition and consequent body-weight loss follow reversely the remainer gastric volume and post-operatory length and have anorexy and intestinal malabsorption as their main causes. Lower food intake is probably due to either emotional factors or chemical mediators acting centrally on hypothalamus. The diarrhea may be due to either increased peristalsis or bacterial overgrowth both aggravated by exocrine-pancreas deficiency and gallbladder overflow. The intestinal malabsorption leading to fecal losses of fat and or nitrogen as well as lower utilization of dietary calcium and liposoluble vitamins. The gastrectomy-related anemia is consequent to lower secretion of both HCl and intrinsic factor leading to a decreased solubilization of iron and lower absorption of vitamin B12, respectively. Body-weight loss and anemia are the protein-energy malnutrition findings often found in these patients whose severity and lasting depend upon the type of surgery, post-surgery length and received nutritional care, being strongly recommended a supervisioned dietary care.

  2. Top nozzle alignment sleeve capture arrangement in a reconstitutable fuel assembly

    International Nuclear Information System (INIS)

    Wilson, J.F.; Gjertsen, R.K.

    1987-01-01

    This patent describes a reconstitutable fuel assembly having at least one control rod guide thimble and a top nozzle, the guide thimble includes an upper end portion. The top nozzle includes an upper hold-down plate having at least one passageway, at least one tubular alignment sleeve slidably extending through the passageway and attachable to and detachable from the guide thimble upper end portion and means supported on the guide thimble upper end portion which, in turn, yieldably mounts the upper hold-down plate for relative movement along the alignment sleeve, an alignment sleeve capture arrangement comprising: (a) means defining a cavity through the upper hold-down plate and in communication with the passageway; the cavity surrounding an upper portion of the alignment sleeve which extends axially through the cavity and the passageway; (b) upper means on the upper hold-down plate surrounding the alignment sleeve upper portion and defining an upper limit of the cavity; (c) lower means on the upper hold-down plate surrounding the alignment sleeve upper portion, spaced below the upper limit defining means, and defining a lower limit of the cavity, one of the upper and lower cavity limit defining means being releasably attached to the upper hold-down plate for facilitating assembly and dissembling of the top nozzle, and (d) enlarged means attached on the alignment sleeve upper portion and having an outside diameter greater than respective inside diameters of the upper and lower cavity limit defining means but less than the inside diameter of the cavity such that the enlarged means can slide within the cavity with the alignment sleeve between upper and lower limits. The upper hold-down plate moves along the alignment sleeve and will retain the alignment sleeve slidably attached to the hold-down plate and when the sleeve is detached from the guide thimble upper end portion

  3. ENDOSCOPIC SLEEVE GASTROPLASTY FOR OBESITY TREATMENT: TWO YEARS OF EXPERIENCE.

    Science.gov (United States)

    Lopez-Nava, Gontrand; Galvão, M P; Bautista-Castaño, I; Fernandez-Corbelle, J P; Trell, M; Lopez, N

    2017-01-01

    Bariatric endoscopic techniques are minimally invasive and induce gastric volume reduction to treat obesity. Aim : To evaluate endoscopic sleeve gastroplasty (Apollo method) using a suturing method directed at the greater curvature, as well as the perioperative care, two year safety and weight loss. Prospective single-center study over 154 patients (108 females) using the endoscopic sleeve gastroplasty procedure under general anesthesia with overnight inpatient observation. Of the154 initial patients, 143 were available for 1-month of follow-up, 133 for 6-month, 64 for 12-month and 28 completed the 24 month assessment. Follow-up was carried out by a multidisciplinary team (nutritionist and psychologist). Outcomes evaluated were: change in BMI; change in body weight (TBWL); % of loss of initial body weight (%TBWL); % of excess body weight loss (%EWL) (segregated in > or 25% %EWL. There were no mayor adverse events intraprocedure or during the 24 months of follow-up . Endoscopic sleeve gastroplasty with regular monitoring by a multidisciplinary team can be considered an effective, safe and well tolerated procedure for obesity treatment, at least for two years of follow-up. As técnicas de endoscopia bariátrica são minimamente invasivas e induzem à redução do volume gástrico para tratar a obesidade. Avaliar a gastroplastia sleeve endoscópica (método Apollo) usando um método de sutura direcionado para a grande curvatura, bem como os cuidados perioperatórios, segurança em dois anos e perda de peso. Estudo prospectivo em um único centro com 154 pacientes (108 mulheres) usando o procedimento endoscópico de gastroplastia sleeve sob anestesia geral com observação do paciente internado durante a noite. Dos 154 pacientes iniciais, 143 estiveram disponíveis para acompanhamento de um mês, 133 durante seis meses, 64 durante 12 meses e 28 completaram a avaliação de 24 meses. O acompanhamento foi realizado por equipe multidisciplinar (nutricionista e psic

  4. Feasibility and profitability of chain integration by NCPAK on flower sleeves products in European market

    NARCIS (Netherlands)

    Yan, X.

    2008-01-01

    In this report, the author describes that the EU flower sleeve wholesalers are the chain leader of the flower sleeve supply chain from China to the EU market. Their strategy changes can easily put NCpak, in full name, 'Sun Hing Plastic Bag Company', a Hong Kong enterprise based on Shenzhen City,

  5. Nylon Sleeve for Cavity Amplifier Holds Tuning Despite Heat

    Science.gov (United States)

    Derr, Lloyd

    1964-01-01

    The problem: Detuning of cavity amplifiers with change in temperature. This results in deterioration of the performance of the amplifier at its design frequency. In cavity amplifiers and filters it is desirable that constant performance be maintained regardless of thermal changes. These changes often cause an "off resonance shift" in a cavity filter and a deterioration of performance in a cavity amplifier. The solution: Mount the tuning probe in a nylon sleeve. Thermal expansion and contraction of the nylon nullifies unwanted capacitive and inductive changes in the resonant elements.

  6. Laparoscopic 'sleeve' caecectomy for idiopathic solitary caecal ulcer mimicking appendicitis.

    Science.gov (United States)

    Sran, Harkiran; Sebastian, Joseph; Doughan, Samer

    2015-08-04

    Idiopathic ulcer of the caecum is a rare condition of unknown aetiology. Its clinical presentation may mimic various pathologies, including appendicitis, inflammatory bowel disease and caecal malignancy. A definitive diagnosis is rarely established preoperatively, and is usually only confirmed histologically following surgical resection. We report a case of a young patient with caecal ulceration presenting with symptoms and signs of appendicitis, in whom laparoscopic anterior 'sleeve' caecectomy was performed to excise an inflammatory-looking mass involving the caecum. Histological examination demonstrated a deep mucosal ulcer and subsequent colonoscopy did not reveal any further pathology. 2015 BMJ Publishing Group Ltd.

  7. Model of radiation transmittance by inorganic fouling on UV reactor lamp sleeves.

    Science.gov (United States)

    Wait, Isaac W; Blatchley, Ernest R

    2010-11-01

    The efficacy of UV disinfection of water depends on the ability of radiation to pass from UV lamps through the quartz sleeves that encase them; the accumulation of metal-containing foulants on sleeve surfaces inhibits disinfection by absorbing radiation that would otherwise be available for inactivation. In a series of experiments, the composition and quantity of sleeve foulants were studied relative to water chemistry and sleeve transmittance. Findings indicate that iron and calcium dominate fouling, with elevated fouling activity by iron, aluminum, manganese, and zinc. A regression-based modeling approach was used to characterize and quantify the effects of foulant metals on UV absorbance. The molar extinction coefficient for iron was found to be more than 3 times greater than that of calcium. Iron's relatively high activity in fouling reactions, elevated capacity to absorb UV, and reduced solubility under oxidizing conditions makes it a fouling precursor of particular concern, with respect to potential for sleeve fouling in UV reactors.

  8. Fretting and Corrosion Damage in Taper Adapter Sleeves for Ceramic Heads: A Retrieval Study.

    Science.gov (United States)

    MacDonald, Daniel W; Chen, Antonia F; Lee, Gwo-Chin; Klein, Gregg R; Mont, Michael A; Kurtz, Steven M; Cates, Harold E; Kraay, Matthew J; Rimnac, Clare M

    2017-09-01

    During revision surgery with a well-fixed stem, a titanium sleeve can be used in conjunction with a ceramic head to achieve better stress distribution across the taper surface. In vitro testing suggests that corrosion is not a concern in sleeved ceramic heads; however, little is known about the in vivo fretting corrosion of the sleeves. The purpose of this study was to investigate fretting corrosion in sleeved ceramic heads in retrieved total hip arthroplasties. Thirty-seven sleeved ceramic heads were collected during revision. The femoral heads and sleeves were implanted 0.0-3.3 years. The implants were revised predominantly for instability, infection, and loosening. Fifty percent of the retrievals were implanted during a primary surgery. Fretting corrosion was assessed using the Goldberg-Higgs semiquantitative scoring system. Mild-to-moderate fretting corrosion scores (score = 2-3) were observed in 92% of internal tapers, 19% of external tapers, and 78% of the stems. Severe fretting corrosion was observed in 1 stem trunnion that was previously retained during revision surgery and none of the retrieved sleeves. There was no difference in corrosion damage of sleeves used in primary or revision surgery. The fretting corrosion scores in this study were predominantly mild and lower than reported fretting scores of cobalt-chrome heads in metal-on-polyethylene bearings. Although intended for use in revisions, we found that the short-term in vivo corrosion behavior of the sleeves was similar in both primary and revision surgery applications. From an in vivo corrosion perspective, sleeves are a reasonable solution for restoring the stem taper during revision surgery. Copyright © 2017. Published by Elsevier Inc.

  9. [Residual stomach, duodenum, and continual jejunal interposition after subtotal gastrectomy].

    Science.gov (United States)

    Zhang, Qin; Ye, Zai-yuan; Yu, Jian-fa; Zhang, Rui-lin; Xu, Ji; Ye, Sheng-ya; Zhang, Qi

    2005-08-10

    To investigate the clinical effect of residual stomach, duodenum, and continual jejunal interposition on the patients of gastric cancer after subtotal gastrectomy. Fifty-four patients with gastric cancer after subtotal gastrectomy were randomly divided into 2 groups: Group A (n = 26, receiving digestive tract reconstruction by manual end-to-side anastomosis of residual stomach and jejunum, end-to-side anastomosis of residual duodenum and jejunum, and side-to-side anastomosis of jejunum and jejunum, then the jejunum proximal to the stomach-jejunum anastomosis and the jejunum distal to the duodenum-jejunum anastomosis were ligated so as to form an integral continual jejunal interposition; and Group B (n = 28, receiving Bilroth digestive tract reconstruction. The operation time, body weight, prognosis nutrition index (PNI), and Visick score 3 and 6 months after the operation were observed. All patients recovered quickly and no complicating anastomosis leakage and obstruction was found. It took 53 +/- 9 minutes to finish the reconstruction in Group A, significantly shorter than that in Group B (57 +/- 6 minutes, t = -2.145, P = 0.037). The body weight and PNI of both groups decreased significantly 3 months after the operation in comparison with those before the operation (both P < 0.05). The body weight and PNI of Group A returned to the levels before operation. Although the body weight and PNI of Group B recovered to some extent 6 months after operation, they remained significantly lower than those before operation both P < 0.05). The Visick score 6 months after operation of Group A was superior to that of Group B (t = 2.1 P < 0.05). Residual stomach, duodenum, and continual jejunal interposition after subtotal gastrectomy helps overcome the difficulty in the procedure of digestive tract reconstruction and restore the physiological passage through duodenum, thus avoiding reflux and improving patients' quality of life.

  10. Laparoscopic Gastric Sleeve and Micronutrients Supplementation: Our Experience

    Directory of Open Access Journals (Sweden)

    D. Capoccia

    2012-01-01

    Full Text Available Background. Laparoscopic gastric sleeve (LGS has been recently introduced as a stand-alone, restrictive bariatric surgery. Theoretically, LGS attenuates micronutrients deficiencies and associated complications that were typically observed following malabsorptive procedures. The aim of this study was to assess some micronutrients and mineral deficiencies in patients undergoing LGS. Methods. In the period between July 2008 and April 2010, 138 obese patients (110 females and 28 males with mean BMI 44.4 kg/m2 ± 6.5, mean age 43.9±10.9 years were enrolled and underwent LGS. Patients were followed up with routine laboratory tests and anthropometric measurements and assessed for nutritional status, as regards vitamin B12, folic acid, iron, hemoglobin, calcium, and vitamin D, every three months throughout 12 months. Results. 12 months after sleeve, patients did not show iron deficiency and/or anemia; plasma calcium levels were in the normal range without supplementation from the sixth month after the operation. Vitamin B12 and folic acid were adequately supplemented for all the follow-up period. Vitamin D was in suboptimal levels, despite daily multivitamin supplementation. Conclusion. In this study, we showed that LGS is an effective surgery for the management of morbid obesity. An adequate supplementation is important to avoid micronutrients deficiencies and greater weight loss does not require higher dosage of multivitamins.

  11. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations

    Science.gov (United States)

    Caruso, Stefano; Patriti, Alberto; Roviello, Franco; De Franco, Lorenzo; Franceschini, Franco; Coratti, Andrea; Ceccarelli, Graziano

    2016-01-01

    Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are

  12. Experimental and numerical studies of various thermal sleeves subjected to severe cyclic thermal shocks

    International Nuclear Information System (INIS)

    Masson, J.C.; Moinereau, D.

    1990-01-01

    During the first operating years of nuclear power plants of different countries, damage was encountered on thermal sleeves used as nozzle protection. Following this discovery studies were initiated to determine the causes and to find solutions. At first a problem of vibration was found and easily solved by reducing gaps and reinforcing the welding of the sleeves. But preliminary tests with cyclic thermal shocks showed a risk of fatigue crack initiation and propagation both in the sleeve fixation and in the nozzle. Therefore a large research and development program was led principally by EDF laboratories of Les Renardieres, to demonstrate the absence of nocivity of thermal shocks during the plants life time [fr

  13. Validation of sleeve of straight union type B for leaks

    Energy Technology Data Exchange (ETDEWEB)

    Teutonico, Mauricio; Fazzini, Pablo [Gie S.A., Buenos Aires (Argentina)

    2009-07-01

    Analytic study and experimental validation of type B sleeve with overlapping, were done in order to determine whether they are suitable for used as permanent leaks repair in hydrocarbons transport lines. All relevant background of this type of repair was analyzed, following the guidelines defined by applicable regulations (ASME B31.8 and ASME B31.4) and modeled by finite elements methods. Solicitations under internal pressure of each one of the reinforcement parts were analyzed. All solicitations involved in welded unions were studied, so as the reinforcement effectiveness when it is filled with internal gap filler. Experimental tests were developed, consisted on the reinforcement installation upon damaged pipes and the following hydrostatic test. These tests were assisted by a digitalized measurement, to determine the solicitations at different parts of the reinforcement; strain gauges were used for this task. (author)

  14. [Post-gastrectomy reconstruction versus enteral alimentation--a one year follow-up study].

    Science.gov (United States)

    Kostov, D; Balabanova, G; Vasilev, B; Plachkov, I; Ignatov, G

    2000-01-01

    This is a report on various post-gastrectomy reconstructive procedures, proceeding from personal experience had with 14 patients undergoing gastrectomy for carcinoma of the stomach and five patients with operations of esophagus and stomach for various pathological conditions. An assessment is done of the reconstructive methods used on the ground of objective indicators. All patients are subjected to enteral alimentation through nutritive jejunostomy. In the pre- and postoperatived periods, the trophic state of patients is evaluated on basis of biochemical, anthropometric and immunologic study data. Postoperatively, in those with small-intestinal reservoir a lower degree negative symptomatology is established, along with life style improvement. Post-gastrectomy patients presenting I-II (UICC) stage of the oncological disease are indicated for small-intestinal reservoir formation. In the overall therapeutic approach to post-gastrectomy patients adequate clinical therapeutic feeding proves absolutely indispensable.

  15. The role of hand-assisted laparoscopic distal gastrectomy for distal gastric cancer.

    Science.gov (United States)

    Kim, Y W; Bae, J M; Lee, J H; Ryu, K W; Choi, I J; Kim, C G; Lee, J S; Rho, J Y

    2005-01-01

    The aim of this study was to evaluate the role of hand-assisted distal gastrectomy (HALDG) for gastric cancer. This study prospectively enrolled 16 patients who underwent HALDG for early gastric cancer and matched them individually by sex, age, and body mass index to patients who underwent laparoscopically assisted distal gastrectomy (LADG) or open distal gastrectomy (ODG). Surgical outcomes were compared among the surgical methods. The mean operating time was the longest for the HALDG group, whereas wound size of the HALDG group was intermediate between that of the LADG and the ODG groups. The other surgical outcomes, such as the number of harvested lymph nodes, were not different among the groups. According to the findings, HALDG may not be as beneficial for patients with early gastric cancer as has been previously suggested. However, because of easier hand-eye coordination, HALDG may be an excellent bridge learning technique as a surgeon gains experience in laparoscopic gastrectomy.

  16. Selective beneficial cardiometabolic effects of vertical sleeve gastrectomy are predominantly mediated through glucagon-like peptide (GLP-1 in Zucker diabetic fatty rats

    Directory of Open Access Journals (Sweden)

    Sunil Kumar

    2016-12-01

    Conclusion: Enhanced GLP-1 secretion post VSG imparted beneficial cardiometabolic effects on blood glucose, insulin, total cholesterol, triglyceride, bile acids and L-PGDS levels which were abated in the presence of GLP-1 antagonist.

  17. Efficacy of ultrasound-guided oblique subcostal transversus abdominis plane block after laparoscopic sleeve gastrectomy: A double blind, randomized, placebo controlled study

    Directory of Open Access Journals (Sweden)

    Mohamed Ibrahim

    2014-07-01

    Conclusion: Oblique subcostal TAP block is a good alternative for providing analgesia during the postoperative period. The block is easily performed using ultrasound guidance. It is safe, provides effective analgesia with significant morphine-sparing effect with reduced side-effects of opioids.

  18. Roux-En-Y gastric bypass and sleeve gastrectomy does not affect food preferences when assessed by an ad libitum buffet meal

    DEFF Research Database (Denmark)

    Nielsen, Mette Søndergaard; Christensen, Bodil Just; Ritz, Christian

    2017-01-01

    surgery (all P ≥ 0.18). In contrast, the picture display test showed that food from the low-fat-savory group was chosen more often post-surgery (34 ± 8% vs. 65 ± 9%, P = 0.02). CONCLUSION: The reduction in energy intake after RYGB and SG surgery and the subsequent weight loss seems to be primarily related...... at the buffet meal with 54% (4491 ± 208 kJ vs. 2083 ± 208 kJ, P fat, low-fat, sweet, savory, high-fat-savory, high-fat-sweet, low-fat-savory, and low-fat-sweet, as well as energy density did not change following...

  19. Laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for morbid obesity: a 1:1 matched cohort study in a Chinese population.

    Science.gov (United States)

    Du, Xiao; Zhang, Si-Qin; Zhou, Hong-Xu; Li, Xue; Zhang, Xiao-Juan; Zhou, Zong-Guang; Cheng, Zhong

    2016-11-15

    This 1:1 matched cohort study with 3-year follow-up aimed to compare the safety and efficacy of LSG with LRYGB for morbid obesity patients. From 2009 to 2013, patients undergoing LRYGB (n = 63) were matched with LSG (n = 63) by gender, age, and body mass index (BMI). Major complications, BMI, percentage of excess weight loss (%EWL), and obesity-related comorbidities after 6, 12, 24, and 36 months were compared. Hospital stay and major complication rates were comparable, but operative time in LSG was significantly shorter (83.2 ± 23.7 vs. 108.3 ± 21.3 min). No significant differences in mean %EWL and BMI were observed at 6, 12, 24 months. At 3-year follow-up, mean %EWL in the LRYGB group was significantly higher than in the LSG group (76.5 ± 9.2% vs. 65.7 ± 10.3%) and, consequently, mean BMI was significantly lower in LRYGB (28.2 ± 1.5 vs. 30.9 ± 2.4 kg/m2). No significant differences in remission of comorbidities were observed at 1- or 3-year follow-up. Both LRYGB and LSG were safe and effective bariatric procedures in this Chinese population, but LRYGB seemed to be superior to LSG in terms of mid-term weight loss.

  20. Damage Effects of Electron Irradiation with Different Energy on Mechanical Properties of Polyethylene Heat-shrinkable Sleeves

    Directory of Open Access Journals (Sweden)

    LIU Yuming

    2016-12-01

    Full Text Available Damage effects of electron irradiation with different energy on mechanical properties of polyethylene heat-shrinkable sleeves were studied by irradiating the sleeves with 45 keV, 1 MeV and 2 MeV electrons respectively. The mechanical property degradations of the sleeves before and after radiations were present. X-ray photoelectron spectra (XPS, scanning electronic microscopy (SEM and Fourier transform infrared spectroscopy (FTIR were used to analyze the element contents, the morphologies and the molecular structures of the samples to study the damage mechanism of the sleeves. A degradation model for the changes of the mechanical properties of the sleeves in electron radiation environment was proposed. It is shown that the increase of irradiation degradation of the polyethylene causes the sleeves' mechanical properties. For the penetration depth of different energy electrons in polyethylene is different, only a shallow layer the sleeves is affected by 45 keV energy electrons, while 1 MeV and 2 MeV energy electrons are penetrated the sleeves and cause the sleeves great damage. The mechanical properties of the sleeves are decreased by about 30% to 40% after 45 keV energy electron irradiation, and decreased by about 100% after 1 MeV and 2 MeV energy electron irradiation.

  1. Development of on line automatic separation device for apple and sleeve

    Science.gov (United States)

    Xin, Dengke; Ning, Duo; Wang, Kangle; Han, Yuhang

    2018-04-01

    Based on STM32F407 single chip microcomputer as control core, automatic separation device of fruit sleeve is designed. This design consists of hardware and software. In hardware, it includes mechanical tooth separator and three degree of freedom manipulator, as well as industrial control computer, image data acquisition card, end effector and other structures. The software system is based on Visual C++ development environment, to achieve localization and recognition of fruit sleeve with the technology of image processing and machine vision, drive manipulator of foam net sets of capture, transfer, the designated position task. Test shows: The automatic separation device of the fruit sleeve has the advantages of quick response speed and high separation success rate, and can realize separation of the apple and plastic foam sleeve, and lays the foundation for further studying and realizing the application of the enterprise production line.

  2. [Wernicke encephalopathy after subtotal gastrectomy for morbid obesity].

    Science.gov (United States)

    Gabaudan, C; La-Folie, T; Sagui, E; Soulier, B; Dion, A-M; Richez, P; Brosset, C

    2008-05-01

    Wernicke's encephalopathy (WE) is one of the potential complications of obesity surgery. It is an acute neuropsychiatric syndrome resulting from thiamine deficiency often associated with repeated vomiting. The classic triad is frequently reported in these patients (optic neuropathy, ataxia and confusion), associated with uncommon features. Cerebral impairment affects the dorsal medial nucleus of the thalamus and the periaqueductal grey area, appearing on MRI, as hyperintense signals on T2, Flair and Diffusion weighted imaging. Early diagnosis and parenteral thiamine are required to decrease morbidity and mortality. We report a case of WE and Korsakoff's syndrome in a young obese patient after subtotal gastrectomy, who still has substantial sequelae. The contribution of MRI with diffusion-weighted imaging is illustrated. The interest of nutritional supervision in the first weeks and preventive thiamine supplementation in case of repeated vomiting are of particular importance in these risky situations.

  3. Reconstruction of the esophagojejunostomy by double stapling method using EEA™ OrVil™ in laparoscopic total gastrectomy and proximal gastrectomy

    Directory of Open Access Journals (Sweden)

    Yano Seiji

    2011-05-01

    Full Text Available Abstract Here we report the method of anastomosis based on double stapling technique (hereinafter, DST using a trans-oral anvil delivery system (EEATM OrVilTM for reconstructing the esophagus and lifted jejunum following laparoscopic total gastrectomy or proximal gastric resection. As a basic technique, laparoscopic total gastrectomy employed Roux-en-Y reconstruction, laparoscopic proximal gastrectomy employed double tract reconstruction, and end-to-side anastomosis was used for the cut-off stump of the esophagus and lifted jejunum. We used EEATM OrVilTM as a device that permitted mechanical purse-string suture similarly to conventional EEA, and endo-Surgitie. After the gastric lymph node dissection, the esophagus was cut off using an automated stapler. EEATM OrVilTM was orally and slowly inserted from the valve tip, and a small hole was created at the tip of the obliquely cut-off stump with scissors to let the valve tip pass through. Yarn was cut to disconnect the anvil from a tube and the anvil head was retained in the esophagus. The end-Surgitie was inserted at the right subcostal margin, and after the looped-shaped thread was wrapped around the esophageal stump opening, assisting Maryland forceps inserted at the left subcostal and left abdomen were used to grasp the left and right esophageal stump. The surgeon inserted anvil grasping forceps into the right abdomen, and after grasping the esophagus with the forceps, tightened the end Surgitie, thereby completing the purse-string suture on the esophageal stump. The main unit of the automated stapler was inserted from the cut-off stump of the lifted jejunum, and a trocar was made to pass through. To prevent dropout of the small intestines from the automated stapler, the automated stapler and the lifted jejunum were fastened with silk thread, the abdomen was again inflated, and the lifted jejunum was led into the abdominal cavity. When it was confirmed that the automated stapler and center rod

  4. Dual-port distal gastrectomy for the early gastric cancer.

    Science.gov (United States)

    Kashiwagi, Hiroyuki; Kumagai, Kenta; Monma, Eiji; Nozue, Mutsumi

    2015-06-01

    Although recent trends in laparoscopic procedures have been toward minimizing the number of incisions, four or five ports are normally required to complete laparoscopic gastrectomy because of the complexity of this procedure. Multi-channel ports, such as the SILS port (Covidien, JAPAN), are now available and are crucial for performing single-incision laparoscopic surgery (SILS) or reduced port surgery (RPS). We carried out reduced port distal gastrectomy (RPDG) using a dual-port method with a SILS port. Ten patients who were diagnosed as early stage gastric cancer were offered the RPDG. Mean age and body mass index (BMI) were 68.1 and 21.4, respectively. No distant metastasis or regional lymph node swelling was seen in any case. A 5-mm flexible scope (Olympus, JAPAN) and SILS port were used and a nylon ligature with a straight needle, instead of a surgical instrument, was available to raise the gastric wall. The average operative time was 266.9 ± 38.3 min and blood loss was 37.8 ± 56.8 ml. Patients recovered well and experienced no complications after surgery. All patients could tolerate soft meals on the first day after surgery and the average hospital stay was 8.1 days. Past conventional LAG cases were evaluated to compare the short-term outcome and no difference was seen in the mean operative time or operative blood loss. The length of hospital stay after surgery was shorter for the RPDG group than the conventional operation group (p < 0.0001). Interestingly, the trend of serum CRP elevation after surgery was lower in the RPDG group than the conventional LAG group (p = 0.053). Although the benefits of RPS have not been established, this type of surgery may be expected to have some advantages. Cosmetic benefits and shorter hospital stays are clear advantages. Less invasiveness can be expected according to the trend of serum CRP elevation after RPDG.

  5. Entirely Laparoscopic Gastrectomy and Colectomy for Remnant Gastric Cancer with Gastric Outlet Obstruction and Transverse Colon Invasion

    OpenAIRE

    Kim, Hyun Il; Kim, Min Gyu

    2015-01-01

    It is well known that gastrectomy with curative intent is the best way to improve outcomes of patients with remnant gastric cancer. Recently,several investigators reported their experiences with laparoscopic gastrectomy of remnant gastric cancer. We report the case of an 83-year-old female patient who was diagnosed with remnant gastric cancer with obstruction. She underwent an entirely laparoscopic distal gastrectomy with colectomy because of direct invasion of the transverse colon. The opera...

  6. Device and process for extracting a blocking sleeve of a nuclear reactor fuel assembly removable guide tube

    International Nuclear Information System (INIS)

    Petit, B.

    1990-01-01

    Removal the blocking sleeve of a nuclear reactor fuel assembly guide tube consits of deforming by bonding towards the inside of the blocking sleeve each of the zones of the formule having a deformed part projecting radially outwards in a manner to remove those deformed parts from location in the corresponding cavity of the tube plate. The blocking sleeve is then extracted by pulling it in the axial direction of the guide tube. A tod is used to bond it the sectors of the formule and grip them to allow extraction of the blocking sleeve by pulling. This extraction is performed under the water of a cooling pool [fr

  7. Total Gastrectomy for Hereditary Diffuse Gastric Cancer at a Single Center: Postsurgical Outcomes in 41 Patients.

    Science.gov (United States)

    Strong, Vivian E; Gholami, Sepideh; Shah, Manish A; Tang, Laura H; Janjigian, Yelena Y; Schattner, Mark; Selby, Luke V; Yoon, Sam S; Salo-Mullen, Erin; Stadler, Zsofia K; Kelsen, David; Brennan, Murray F; Coit, Daniel G

    2017-12-01

    The aim of this study was to describe postoperative outcomes of total gastrectomy at our institution for patients with hereditary diffuse gastric cancer (HDGC). HDGC, which is mainly caused by germline mutations in the E-cadherin gene (CDH1), renders a lifetime risk of gastric cancer of up to 70%, prompting a recommendation for prophylactic total gastrectomy. A prospective gastric cancer database identified 41 patients with CDH1 mutation who underwent total gastrectomy during 2005 to 2015. Perioperative, histopathologic, and long-term data were collected. Of the 41 patients undergoing total gastrectomy, median age was 47 years (range 20 to 71). There were 14 men and 27 women, with 25 open operations and 16 minimally invasive operations. Median length of stay was 7 days (range 4 to 50). In total, 11 patients (27%) experienced a complication requiring intervention, and there was 1 peri-operative mortality (2.5%). Thirty-five patients (85%) demonstrated 1 or more foci of intramucosal signet ring cell gastric cancer in the examined specimen. At 16 months median follow-up, the median weight loss was 4.7 kg (15% of preoperative weight). By 6 to 12 months postoperatively, weight patterns stabilized. Overall outcome was reported to be "as expected" by 40% of patients and "better than expected" by 45%. Patient-reported outcomes were similar to those of other patients undergoing total gastrectomy. Total gastrectomy should be considered for all CDH1 mutation carriers because of the high risk of invasive diffuse-type gastric cancer and lack of reliable surveillance options. Although most patients have durable weight loss after total gastrectomy, weights stabilize at about 6 to 12 months postoperatively, and patients report outcomes as being good to better than their preoperative expectations. No patients have developed gastric cancer recurrence after resections.

  8. Petroleum hydrocarbon sparging from intact core sleeve samples

    International Nuclear Information System (INIS)

    Ostendorf, D.W.; Moyer, E.E.; Hinlein, E.S.

    1993-01-01

    The authors measured and modeled hydrocarbons vapor constituent sparging out of residually contaminated soil in two intact core sleeves from the US Coast Guard Air Station in northern Michigan. The LNAPL source was a 0.3 m thick zone of residual aviation gasoline in the contaminated capillary fringe about 5 m below the ground surface in uniform sandy soil. The sampling location was far downgradient of the origin of the fuel spill, so that the configuration of separate phase contamination was due to surface tension in the capillary fringe and trapping by a historically fluctuating water table. The gas sparging efficiency was assessed with a simple transport model balancing gaseous advection and a zero order source term. The predicted vertical profiles accurately matched the data for all constitutents, exhibiting source strengths that compared favorably with values from a companion study of diffusive soil venting. The sparging efficiency was found to be independent of gas flow rate, so that low flows generate relatively high exit concentrations. This finding suggests that local mass transport constrains the removal efficiency for LNAPL sources trapped by fluctuating water tables

  9. Numerical Simulation of the Liquid-Gas Interface Shape in the Shot Sleeve of Cold Chamber Die Casting Machine

    Science.gov (United States)

    Han, Tsung-Hsien; Kuo, Jer-Haur; Hwang, Weng-Sing

    2007-10-01

    A mathematical model has been developed to simulate the flow pattern of molten metal and to predict the liquid-gas interface shape in the shot sleeve of a cold chamber die casting machine during the injection stage. The flow pattern in the shot sleeve is known to be closely related to the extent of gas entrapment of molten metal in the sleeve during the injection operation. In this study, a Variable Spacing Even Mesh (VSEM) method is proposed to incorporate with a computational fluid dynamics technique, named SOLA-MAC, to simulate the flow pattern in the shot sleeve. SOLA-MAC can deal with free surface flow problems while the VSEM method is used to handle the problem where the space in the shot sleeve keeps decreasing as the plunger moves to push the molten metal. The model is then tested on the shot sleeve of a cold chamber die casting machine. Four plunger speeds are tested to demonstrate the effects on the flow pattern of molten metal in the shot sleeve. The critical speed found in this study is 38 cm/s and it is close to the reported critical speed under the conditions that the space between the plunger and the sleeve end is 5 cm in diameter and 30 cm in length, and the fill ratio is 50%. As the plunger speed is slower than the critical speed, the wave front propagates along the sleeve faster than the plunger and reflects against the end wall of the sleeve. The remaining air in the shot sleeve is entrained as the wave front enters to the gate. As the plunger speed is higher than the suggested critical speed, the melt is immediately pushed higher in front of the plunger and forms a surge. The surge traps air in the early stage of the injection process.

  10. Nutritional assessment methods as predictors of postoperative mortality in gastric cancer patients submitted to gastrectomy

    Directory of Open Access Journals (Sweden)

    Aline Kirjner Poziomyck

    Full Text Available ABSTRACT Objectives: to determine the nutritional evaluation method that best predicts mortality in 90 days of patients submitted to gastrectomy for gastric cancer. Methods: we conducted a prospective study with 44 patients with gastric cancer, stages II to IIIa, of whom nine were submitted to partial gastrectomy, 34 to total gastrectomy, and one to esophago-gastrectomy. All patients were nutritionally evaluated through the same protocol, up to 72h after hospital admission. The parameters used were Patient-Generated Subjective Global Assessment (PGSGA, classical anthropometry, current weight and height, percentage of weight loss (%WL and body mass index (BMI. We also measured the thickness of the thumb adductor muscle (TAM in both hands, dominant hand (TAMD and non-dominant hand (TAMND, as well as the calculated the prognostic nutritional index (PNI. The laboratory profile included serum levels of albumin, erythrocytes, hemoglobin, hematocrit, leukocytes, and total lymphocytes count (TLC. Results: of the 44 patients studied, 29 (66% were malnourished by the subjective method, 15 being grade A, 18 grade B and 11 grade C. Cases with PGSGA grade B and TAMD 10.2±2.9 mm were significantly associated with higher mortality. The ROC curves (95% confidence interval of both PGSGA and TAMD thickness reliably predicted mortality at 30 and 90 days. No laboratory method allowed predicting mortality at 90 days. Conclusion: PGSGA and the TAMD thickness can be used as preoperative parameters for risk of death in patients undergoing gastrectomy for gastric cancer.

  11. Preoperative determination of appropriate cutting line for proximal gastrectomy to avoid postoperative jejunal ulcer.

    Science.gov (United States)

    Takahashi, Naoto; Kashimura, Hirotaka; Nimura, Hiroshi; Watanabe, Atsushi; Yano, Kentaro; Aoki, Hiroaki; Koyama, Tomoki; Sasaki, Toshiyuki; Shida, Atsuo; Mitsumori, Norio; Aoki, Teruaki; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

    2012-01-01

    Although proximal gastrectomy has become a procedure of choice for patients' early cancer in the upper third of stomach, no clinical guide for optimal gastric resection in order to avoid postoperative jejunal ulcer is available. The aim of this study was to investigate whether determining the distribution of parietal and chief cells of the stomach using Congo red test is clinically relevant. The F-line was defined as a boundary line between fundic and intermediate area of the stomach according to the pathological findings in 29 patients who underwent total gastrectomy for early gastric cancer, whereas the f-line was regarded as a boundary line between intermediate and pyloric area. In the additional 6 patients undergoing vagus-preserving proximal gastrectomy with jejunal pouch interposition, endoscopic Congo red test was preoperatively performed to determine the F-f-line. The distances from the pyloric ring to f-line on the lesser and greater curvatures were variable. Long-term outcomes of proximal gastrectomy guided by preoperative endoscopic Congo red test were favorable. It is suggested that preoperative endoscopic Congo red test is useful to determine the appropriate cutting line in order to avoid postoperative jejunal ulcer after proximal gastrectomy.

  12. Status and Prospects of Robotic Gastrectomy for Gastric Cancer: Our Experience and a Review of the Literature

    Directory of Open Access Journals (Sweden)

    Sejin Lee

    2017-01-01

    Full Text Available Since the first report of robotic gastrectomy, experienced laparoscopic surgeons have used surgical robots to treat gastric cancer and resolve problems associated with laparoscopic gastrectomy. However, compared with laparoscopic gastrectomy, the superiority of robotic procedures has not been clearly proven. There are several advantages to using robotic surgery for gastric cancer, such as reduced estimated blood loss during the operation, a shorter learning curve, and a larger number of examined lymph nodes than conventional laparoscopic gastrectomy. The increased operation time observed with a robotic system is decreasing because surgeons have accumulated experience using this procedure. While there is limited evidence, long-term oncologic outcomes appear to be similar between robotic and laparoscopic gastrectomy. Robotic procedures have a significantly greater financial cost than laparoscopic gastrectomy, which is a major drawback. Recent clinical studies tried to demonstrate that the benefits of robotic surgery outweighed the cost, but the overall results were disappointing. Ongoing studies are investigating the benefits of robotic gastrectomy in more complicated and challenging cases. Well-designed randomized control trials with large sample sizes are needed to investigate the benefits of robotic gastrectomy compared with laparoscopic surgery.

  13. Crimped braided sleeves for soft, actuating arm in robotic abdominal surgery.

    Science.gov (United States)

    Elsayed, Yahya; Lekakou, Constantina; Ranzani, Tommaso; Cianchetti, Matteo; Morino, Mario; Arezzo, Alberto; Menciassi, Arianna; Geng, Tao; Saaj, Chakravarthini M

    2015-01-01

    This paper investigates different types of crimped, braided sleeve used for a soft arm for robotic abdominal surgery, with the sleeve required to contain balloon expansion in the pneumatically actuating arm while it follows the required bending, elongation and diameter reduction of the arm. Three types of crimped, braided sleeves from PET (BraidPET) or nylon (BraidGreyNylon and BraidNylon, with different monofilament diameters) were fabricated and tested including geometrical and microstructural characterisation of the crimp and braid, mechanical tests and medical scratching tests for organ damage of domestic pigs. BraidPET caused some organ damage, sliding under normal force of 2-5 N; this was attributed to the high roughness of the braid pattern, the higher friction coefficient of polyethylene terephthalate (PET) compared to nylon, and the high frequency of the crimp peaks for this sleeve. No organ damage was observed for the BraidNylon, attributed to both the lower roughness of the braid pattern and the low friction coefficient of nylon. BraidNylon also required the lowest tensile force during its elongation to similar maximum strain as that of BraidPET, translating to low power requirements. BraidNylon is recommended for the crimped sleeve of the arm designed for robotic abdominal surgery.

  14. Influence of geometrical parameters of convergent sleeve on the value of limit stress

    Directory of Open Access Journals (Sweden)

    Górecki Jan

    2018-01-01

    Full Text Available This paper presents the results of research on improving the effectiveness of the agglomeration process. Improving effectiveness was obtained as a result of the application of the convergent sleeve. The sleeve is mounted before the multi-holes die in the dry ice agglomeration machine. The empirical part of the paper presents the results of research on which FEM model was based. The numerical part of research presents the FEM model of the agglomeration process. The FEM model with a known uncertainty level was used to determine the influence of geometrical parameters of the sleeve on the limit value of the agglomeration forces. The model will be one of the starting points for the design and construction of the machine for the compaction and granulation of dry ice.

  15. Predictive factors for body weight loss and its impact on quality of life following gastrectomy.

    Science.gov (United States)

    Tanabe, Kazuaki; Takahashi, Masazumi; Urushihara, Takashi; Nakamura, Yoichi; Yamada, Makoto; Lee, Sang-Woong; Tanaka, Shinnosuke; Miki, Akira; Ikeda, Masami; Nakada, Koji

    2017-07-14

    To determine the predictive factors and impact of body weight loss on postgastrectomy quality of life (QOL). We applied the newly developed integrated questionnaire postgastrectomy syndrome assessment scale-45, which consists of 45 items including those from the Short Form-8 and Gastrointestinal Symptom Rating Scale instruments, in addition to 22 newly selected items. Between July 2009 and December 2010, completed questionnaires were received from 2520 patients with curative resection at 1 year or more after having undergone one of six types of gastrectomy for Stage I gastric cancer at one of 52 participating institutions. Of those, we analyzed 1777 eligible questionnaires from patients who underwent total gastrectomy with Roux-en-Y procedure (TGRY) or distal gastrectomy with Billroth-I (DGBI) or Roux-en-Y (DGRY) procedures. A total of 393, 475 and 909 patients underwent TGRY, DGRY, and DGBI, respectively. The mean age of patients was 62.1 ± 9.2 years. The mean time interval between surgery and retrieval of the questionnaires was 37.0 ± 26.8 mo. On multiple regression analysis, higher preoperative body mass index, total gastrectomy, and female sex, in that order, were independent predictors of greater body weight loss after gastrectomy. There was a significant difference in the degree of weight loss ( P 25 kg/m 2 ). Multiple linear regression analysis identified lower postoperative body mass index, rather than greater body weight loss postoperatively, as a certain factor for worse QOL ( P weight after gastrectomy, the impact of body weight loss on QOL is unexpectedly small.

  16. EVALUATION OF N-RATIO IN SELECTING PATIENTS FOR ADJUVANT CHEMORADIOTHERAPY AFTER D2-GASTRECTOMY

    Directory of Open Access Journals (Sweden)

    Wilson Luiz da COSTA JUNIOR

    2013-12-01

    Full Text Available Context Whether adjuvant chemoradiotherapy may contribute to improve survival outcomes after D2-gastrectomy remains controvertial. Objective To explore the clinical utility of N-Ratio in selecting gastric cancer patients for adjuvant chemoradiotherapy after D2-gastrectomy. Methods A retrospective cohort study was carried out on gastric cancer patients who underwent D2-gastrectomy alone or D2-gastrectomy plus adjuvant chemoradiotherapy (INT-0116 protocol at the Hospital A. C. Camargo from September 1998 to December 2008. Statistical analysis were performed using multiple conventional methods, such as c-statistic, adjusted Cox's regression and stratified survival analysis. Results Our analysis involved 128 patients. According to c-statistic, the N-Ratio (i.e., as a continuous variable presented “area under ROC curve” (AUC of 0.713, while the number of metastatic nodes presented AUC of 0.705. After categorization, the cut-offs provide by Marchet et al. displayed the highest discriminating power – AUC value of 0.702. This N-Ratio categorization was confirmed as an independent predictor of survival using multivariate analyses. There also was a trend of better survival by adding of adjuvant chemoradiotherapy only for patients with milder degrees of lymphatic spread – 5-year survival of 23.1% vs 66.9%, respectively (HR = 0.426, 95% CI 0.150–1.202; P = 0.092. Conclusions This study confirms the N-Ratio as a tool to improve the lymph node metastasis staging in gastric cancer and suggests the cut-offs provided by Marchet et al. as the best way for its categorization after a D2-gastrectomy. In these settings, the N-Ratio appears a useful tool to select patients for adjuvant chemoradiotherapy, and the benefit of adding this type of adjuvancy to D2-gastrectomy is suggested to be limited to patients with milder degrees of lymphatic spread (i.e., NR2, 10%–25%.

  17. A study by upper digestive tract scintigraphy of cases with recurrent pneumonia after gastrectomy

    International Nuclear Information System (INIS)

    Yokomura, Ichiro; Fukabori, Takashi; Mizobuchi, Kazuya; Yoneda, Mitsuru; Yagi, Yasuo; Nakamura, Mitsuo

    1997-01-01

    Five patients with recurrent pneumonia after gastrectomy were studied by upper digestive tract scintigraphy. Severe gastroesophageal reflux was noted in three of the five patients in the supine position. In the other two patients, the same kind of reflux was easily induced by changing position. Esophageal dysfunction was suspected in four patients. The frequency of pneumonia decreased after we instructed the patients how to avoid reflux. We therefore diagnosed it as the chronic aspiration pneumonia. We concluded that upper digestive tract scintigraphy is useful for evaluating gastroesophageal reflux and esophageal function in patients after gastrectomy. (author)

  18. Full robot-assisted gastrectomy with intracorporeal robot-sewn anastomosis produces satisfying outcomes

    Science.gov (United States)

    Liu, Xin-Xin; Jiang, Zhi-Wei; Chen, Ping; Zhao, Yan; Pan, Hua-Feng; Li, Jie-Shou

    2013-01-01

    AIM: To evaluate the feasibility and safety of full robot-assisted gastrectomy with intracorporeal robot hand-sewn anastomosis in the treatment of gastric cancer. METHODS: From September 2011 to March 2013, 110 consecutive patients with gastric cancer at the authors’ institution were enrolled for robotic gastrectomies. According to tumor location, total gastrectomy, distal or proximal subtotal gastrectomy with D2 lymphadenectomy was fully performed by the da Vinci Robotic Surgical System. All construction, including Roux-en-Y jejunal limb, esophagojejunal, gastroduodenal and gastrojejunal anastomoses were fully carried out by the intracorporeal robot-sewn method. At the end of surgery, the specimen was removed through a 3-4 cm incision at the umbilicus trocar point. The details of the surgical technique are well illustrated. The benefits in terms of surgical and oncologic outcomes are well documented, as well as the failure rate and postoperative complications. RESULTS: From a total of 110 enrolled patients, radical gastrectomy could not be performed in 2 patients due to late stage disease; 1 patient was converted to laparotomy because of uncontrollable hemorrhage, and 1 obese patient was converted due to difficult exposure; 2 patients underwent extra-corporeal anastomosis by minilaparotomy to ensure adequate tumor margin. Robot-sewn anastomoses were successfully performed for 12 proximal, 38 distal and 54 total gastrectomies. The average surgical time was 272.52 ± 53.91 min and the average amount of bleeding was 80.78 ± 32.37 mL. The average number of harvested lymph nodes was 23.1 ± 5.3. All specimens showed adequate surgical margin. With regard to tumor staging, 26, 32 and 46 patients were staged as I, II and III, respectively. The average hospitalization time after surgery was 6.2 d. One patient experienced a duodenal stump anastomotic leak, which was mild and treated conservatively. One patient was readmitted for intra-abdominal infection and was

  19. Lifetime Extension of Welded Sleeves for Pipeline Repair Based on Computer Simulation

    Directory of Open Access Journals (Sweden)

    A. S. Kurkin

    2015-01-01

    Full Text Available The exhausted design lifetime of main pipelines makes it necessary to extend their service life up to 100 years. This explains the urgency for development of repair designs providing postrepair lifetime level equal to the intact pipe. The paper presents the parametric study results of methods for increasing the lifetime of sleeves after repair to restore the pipeline functionality. Based on analysis of the stress state under external loads the paper offers a computer-simulated option of the sleeve design to provide a significantly increased lifetime.

  20. Trends in gastrectomy and ADH1B and ALDH2 genotypes in Japanese alcoholic men and their gene-gastrectomy, gene-gene and gene-age interactions for risk of alcoholism.

    Science.gov (United States)

    Yokoyama, Akira; Yokoyama, Tetsuji; Matsui, Toshifumi; Mizukami, Takeshi; Kimura, Mitsuru; Matsushita, Sachio; Higuchi, Susumu; Maruyama, Katsuya

    2013-01-01

    The life-time drinking profiles of Japanese alcoholics have shown that gastrectomy increases susceptibility to alcoholism. We investigated the trends in gastrectomy and alcohol dehydrogenase-1B (ADH1B) and aldehyde dehydrogenase-2 (ALDH2) genotypes and their interactions in alcoholics. This survey was conducted on 4879 Japanese alcoholic men 40 years of age or older who underwent routine gastrointestinal endoscopic screening during the period 1996-2010. ADH1B/ALDH2 genotyping was performed in 3702 patients. A history of gastrectomy was found in 508 (10.4%) patients. The reason for the gastrectomy was peptic ulcer in 317 patients and gastric cancer in 187 patients. The frequency of gastrectomy had gradually decreased from 13.3% in 1996-2000 to 10.5% in 2001-2005 and to 7.8% in 2006-2010 (P alcoholism-susceptibility genotypes, ADH1B*1/*1 and ALDH2*1/*1, modestly but significantly tended not to occur in the same individual (P = 0.026). The frequency of ADH1B*1/*1 decreased with ascending age groups. The high frequency of history of gastrectomy suggested that gastrectomy is still a risk factor for alcoholism, although the percentage decreased during the period. The alcoholism-susceptibility genotype ADH1B*1/*1 was less frequent in the gastrectomy group, suggesting a competitive gene-gastrectomy interaction for alcoholism. A gene-gene interaction and gene-age interactions regarding the ADH1B genotype were observed.

  1. Bariatric surgery in Singapore from 2005 to 2009

    Directory of Open Access Journals (Sweden)

    Rajat Goel

    2013-01-01

    Conclusion: There is a flux of newer procedures in Singapore. Adjustable gastric banding, which was the only available procedure being performed in 2004, was gradually being replaced by other procedures such as sleeve gastrectomy and Roux-en-Y gastric bypass in 2009.

  2. HYBASE : HYperspectral BAnd SElection

    NARCIS (Netherlands)

    Schwering, P.B.W.; Bekman, H.H.P.T.; Seijen, H.H. van

    2009-01-01

    Band selection is essential in the design of multispectral sensor systems. This paper describes the TNO hyperspectral band selection tool HYBASE. It calculates the optimum band positions given the number of bands and the width of the spectral bands. HYBASE is used to assess the minimum number of

  3. Endoscopic sleeve gastroplasty (the Apollo method: a new approach to obesity management

    Directory of Open Access Journals (Sweden)

    Gontrand López-Nava-Breviere

    2016-04-01

    Full Text Available Background: Many obese patients cannot lose weight or reject conventional obesity management. Endoscopic sleeve gastroplasty (the Apollo method is a pioneering coadjuvant, interventionist technique for the integral management of obesity. Objectives: The goals of this study were to report safety and efficacy results obtained at 6 months in patients undergoing endoscopic sleeve gastroplasty. Material and methods: A prospective study was performed in 55 patients (13 males, 42 females who were subjected to the Apollo technique; mean age was 43.5 years (range 25-60 and mean BMI was 37.7 kg/m² (range 30-48. All received multidisciplinary follow-up for weight loss. Weight changes and presence of complications were assessed. Through the endoscope a triangular pattern suture is performed consisting of approximately 3-6 transmural (mucosa to serosa stitches, using a cinch device to bring them nearer and form a plication. Results: A total of 6-8 plications are used to provide a tubular or sleeve-shaped restriction to the gastric cavity. No major complications developed and patients were discharged at 24 hours following the procedure. Endoscopic and radiographic follow-up at 6 months post-procedure showed a well preserved tubular form to the stomach. After 6 months patients had lost 18.9 kg and 55.3% of excess weight. Conclusions: Endoscopic sleeve gastroplasty, together with dietary and psycho-behavioral changes, is a safe, effective technique in the coadjuvant management of obese patients.

  4. Concept for sleeve induction motor with 1-msec mechanical time constant

    Science.gov (United States)

    Wiegand, D. E.

    1968-01-01

    Conductive sleeve induction motor having a 1-msec mechanical time constant is used with solid-state devices to control all-electric servo power systems. The servomotor rotor inertia is small compared to the maximum force rating of the servo motion, permitting high no-load acceleration.

  5. Modified Sleeve Technique in Aortic Valve-Sparing Operation for Marfan Syndrome.

    Science.gov (United States)

    Wu, Yung-Szu; Hsieh, Shih-Rong; Wang, Chung-Chi; Tsai, Chung-Lin

    2018-03-22

    We devised a simple modification of the Florida Sleeve procedure to perform aortic valve-sparing surgery. This technique is simple, quick, effective, and safe. We used this technique in operations performed on two young patients with Marfan syndrome. The initial and short-term results were satisfactory.

  6. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...

  7. Rotor losses in laminated magnets and an anisotropic carbon fiber sleeve

    NARCIS (Netherlands)

    Van der Geest, M.; Wolmarans, J.J.; Polinder, H.; Ferreira, J.A.; Zeilstra, D.

    2012-01-01

    High speed fault tolerant permanent magnet machines have strong asynchronous airgap harmonics, making them susceptible to rotor eddy-current losses. These losses can be reduced by using novel high resistivity materials like plastic bonded magnets and carbon fiber reinforced retaining sleeves. This

  8. Repairing or protecting process for heat exchanger metallic tubes and sleeve to make use

    International Nuclear Information System (INIS)

    Vigneron, G.; Bezier, J.; Thanh, T.N.; Vidal, P.; Zacharie, G.; Guillemin, L.

    1988-01-01

    For repairing the end of metal heat exchanger tube a sleeve is introduced into the tube and subjected to a localized dudgeonning process. Welds are made in the dudgeonning zone. After these operations a series of dudgeonning passes are made above the welds in the tubular plate zone [fr

  9. The Single Needle Lockstitch Machine. [Constructing and Setting Sleeves.] Module 7.

    Science.gov (United States)

    South Carolina State Dept. of Education, Columbia. Office of Vocational Education.

    This module on constructing and setting sleeves, one in a series on the single needle lockstitch sewing machine for student self-study, contains two sections. Each section includes the following parts: an introduction, directions, an objective, learning activities, student information, student self-check, check-out activities, and an instructor's…

  10. Jejunogastric intussusception after distal gastrectomy with Roux-en-Y reconstruction: A case report.

    Science.gov (United States)

    Kawano, Fumiaki; Tashiro, Kousei; Nakao, Hironobu; Fujii, Yoshirou; Ikeda, Takuto; Takeno, Shinsuke; Nakamura, Kunihide; Nanashima, Atsushi

    2018-01-01

    Jejunogastric intussusception is a rare complication after gastric operation. Intussusception after gastric operation occurs mostly at the gastrojejunal anastomosis site and Braun anastomosis site of Billroth II reconstruction, and at the Y anastomosis site of Roux-en-Y reconstruction. However, jejunogastric intussusception after distal gastrectomy with Roux-en-Y reconstruction is very rare. We report a surgical case of jejunogastric intussusception after distal gastrectomy for gastric cancer treatment. An 82-year-old woman underwent laparoscopic distal gastrectomy for early gastric cancer treatment. Reconstruction was performed using Roux-en-Y anastomosis. Oral intake was started on postoperative day 4, however vomiting and high-grade fever occurred on postoperative day 12, after which oral intake became difficult. Anastomotic stenosis of the gastrojejunostomy was suspected, and various examinations were performed. Gastroendoscopy and computed tomography revealed an elevated lesion with ring-like folds protruding through the anastomosis site into the remnant stomach. Reoperation was performed on postoperative day 28 after a diagnosis of jejunogastric intussusception was made. It failed to reduce the intussusception, so partial resection of the gastrojejunal anastomosis was performed and Roux-en-Y reconstruction was repeated. Reconstruction was conducted after taking into consideration the recurrence of intussusception. Jejunogastric intussusceptions after distal gastrectomy is a rare complication; however, when it occurs, early diagnosis and appropriate management are necessary. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  11. Esophagojejunostomy reconstruction using a robot-sewing technique during totally robotic total gastrectomy for gastric cancer.

    Science.gov (United States)

    Jiang, Zhi-Wei; Liu, Jiang; Wang, Gang; Zhao, Kun; Zhang, Shu; Li, Ning; Li, Jie-Shou

    2015-01-01

    The aim of this study was to report on the feasibility of esophagojejunostomy reconstruction using a robot-sewing technique during a completely robotic total gastrectomy for gastric cancer. Between May 2011 and July 2012, 65 patients in whom gastric adenocarcinoma was diagnosed underwent a completely robotic total gastrectomy, including a robot-sewing esophagojejunal anastomosis. We demonstrated the surgical techniques with analysis of clinicopathologic data and short-term surgical outcomes. All robotic surgeries were successfully performed without conversion. Among the 65 patients, 46 were men and 19 were women. The mean age (± SD) was 57.8 ± 6.5 y. The mean total operative time (± SD), EJ anastomosis time (± SD), and blood loss (± SD) were 245 ± 53 min, 45 ± 26 min, and 75 ± 50 ml, respectively. The mean (± SD) post-operative hospital stay was 5.4 ± 2.5 d. One patient was readmitted for an intestinal obstruction and underwent re-operation 14 d post-operatively; he recovered uneventfully and was discharged 10 d post- operatively. During the follow-up, no patients developed an esophgojejunostomy stricture. A robot-sewing anastomosis for esophagojejunostomy reconstruction during robotic total gastrectomy for gastric cancer is feasible. Indeed, a robot-sewing anastomosis for esophagojejunostomy reconstruction may become a standard surgical technique during completely robotic total gastrectomy for gastric cancer.

  12. One-day nasogastric tube decompression after distal gastrectomy: a prospective randomized study.

    Science.gov (United States)

    Kimura, Yutaka; Yano, Hiroshi; Iwazawa, Takashi; Fujita, Junya; Fujita, Shoichiro; Yamamoto, Kazuyoshi; Yasuda, Takushi

    2017-09-01

    Many surgeons in Japan use 1-day nasogastric tube (NGT) decompression after gastrectomy as a standard procedure. This prospective randomized study aimed to define whether 1-day NGT decompression is necessary after distal gastrectomy. The subjects were 233 patients with gastric cancer, randomized into two groups immediately after distal gastrectomy: one group received 1-day NGT decompression (NGT group, n = 119) and the other did not (no-NGT group, n = 114). The primary outcome measure was postoperative surgery-related and respiratory complications, whereas secondary measures were the postoperative course to recovery and patient complaints. The incidence of surgery-related complications did not differ significantly between the NGT and no-NGT groups (21.0 and 19.2%, respectively; p = 0.87). The rate of respiratory complications was 6.7% in the NGT group and 7.0% in the no-NGT group (p > 0.99). The time to passage of first flatus and the postoperative hospital stay did not differ between the groups. Twenty-five patients in the NGT group and none in the no-NGT group complained of nasopharyngeal discomfort (p < 0.0001). Considering the physical discomfort caused by the NGT, we believe that routine 1-day NGT decompression is unnecessary after distal gastrectomy.

  13. Development of Wernicke-Korsakoff syndrome after long intervals following gastrectomy.

    Science.gov (United States)

    Shimomura, T; Mori, E; Hirono, N; Imamura, T; Yamashita, H

    1998-09-01

    Surgical exclusion of portions of the gastrointestinal tract is a predisposing risk factor for the development of Wernicke-Korsakoff syndrome. When this disease occurs, it is usually within weeks after the gastrointestinal surgery. However, it is not well known that Wernicke-Korsakoff syndrome may occur after a long latent interval following gastrectomy. A research-oriented hospital. Three patients without a history of alcoholism or dietary deprivation developed Wernicke-Korsakoff syndrome 2 to 20 years after undergoing gastrectomy. In these patients, minor changes in dietary habit led to the development of Wernicke-Korsakoff syndrome. In addition to a long-standing latent deficiency in thiamin levels due to defective absorption following gastrectomy or gastrojejunostomy, other minor factors that may influence the intake of thiamin and the need for thiamin in subjects who have undergone gastrectomy may cause a state of thiamin deficiency resulting in Wernicke-Korsakoff syndrome. Results from our study indicate that the following measures are mandatory: educating patients about proper dietary habits, carefully monitoring their thiamin intake, recognizing Wernicke-Korsakoff syndrome early, and treating it immediately with appropriate measures.

  14. Bile duct stone formation around a nylon suture after gastrectomy: a case report.

    Science.gov (United States)

    Maeda, Chiyo; Yokoyama, Naoyuki; Otani, Tetsuya; Katada, Tomohiro; Sudo, Natsuru; Ikeno, Yoshinobu; Matsuura, Fumiaki; Iwaya, Akira; Yamazaki, Toshiyuki; Kuwabara, Shirou; Katayanagi, Norio

    2013-03-22

    Many cases of choledocholiths formed around sutures and clips used during cholecystectomy have been reported. We describe a case of gallstone formation around a nylon suture after non-biliary surgery. To the best of our knowledge, this is the first report of such a case. A 75-year-old Japanese man, who had undergone distal gastrectomy for gastric cancer and reconstruction with the Billroth II method 8 years earlier, presented with gastric discomfort. Abdominal ultrasonography was conducted and we diagnosed cholecysto-choledocholithiasis with dilatation of the intrahepatic bile duct. He underwent cholecystectomy and cholangioduodenostomy for choledocholith removal. Gallstones, which had formed around a nylon suture used during the previous gastrectomy, were found in the bile duct. Sutures of the same material had also been placed on the duodenum. Chemical analysis revealed that the stones were composed of calcium bilirubinate. The patient was discharged on postoperative day 19, and choledocholithiasis has not recurred thus far. The findings from this case suggest that standard, non-resorbable sutures used in gastrectomy may be associated with the formation of bile duct stones; therefore, absorbable suture material may be required to avert gallstone formation even in the case of gastrectomy.

  15. Proper preparation to reduce endoscopic reexamination due to food residue after distal gastrectomy for gastric cancer.

    Science.gov (United States)

    Ahn, Ji Yong; Jung, Hwoon-Yong; Bae, Sue Eun; Jung, Ji Hoon; Choi, Ji Young; Kim, Mi-Young; Lee, Jeong Hoon; Choi, Kwi-Sook; Kim, Do Hoon; Choi, Kee Don; Song, Ho June; Lee, Gin Hyug; Kim, Jin-Ho; Han, Seungbong

    2013-03-01

    Reducing food residue by proper preparation methods before endoscopy after distal gastrectomy can increase the quality of examination and decrease patient discomfort. We evaluated the risk factors for food residue and proper methods of preparation for endoscopy after distal gastrectomy. Follow-up endoscopy with questionnaires was performed on 1,001 patients who underwent distal gastrectomy at Asan Medical Center between December 2010 and July 2011. Endoscopic examination failed in 94 patients (9.4 %) as a result of large amounts of food residue. Rates of failure were significantly higher in patients who ate a regular diet rather than a soft diet at last dinner before examination (13.9 vs. 6.1 %, p = 0.050), and in those who ate lunch rather than not eating lunch on the day before examination (14.6 vs. 7.7 %, p = 0.020). Multivariate analysis showed that the rate of failed examination was lower in patients who had a history of abdominal surgery (p = 0.011), those who ate a soft (p fasting time (p = 0.009), and those with a longer gastrectomy-to-endoscopy time interval (p fast more than 18 h and ingest a soft or liquid diet on the day before examination.

  16. Remote partial gastrectomy as a risk factor for pancreatic cancer: potential for preventive strategies

    NARCIS (Netherlands)

    van Rees, B. P.; Tascilar, M.; Hruban, R. H.; Giardiello, F. M.; Tersmette, A. C.; Offerhaus, G. J.

    1999-01-01

    Pancreatic cancer is the fifth leading cause of cancer death mainly because of an advanced disease stage at the time of diagnosis. Patients with a remote partial gastrectomy for benign ulcer disease may constitute a high risk group for pancreatic cancer; an increased index of suspicion could

  17. Development of a high speed extrusion concept using a floating screw sleeve for solid-melt-separation

    Science.gov (United States)

    Karrenberg, Gregor; Wortberg, Johannes

    2015-05-01

    The High-Speed-S-Truder with floating screw sleeve is an alternative extrusion concept with solid-melt-separation. A fairly conventional 35 mm screw with a length of 21 D, which is accelerated by a 75 kW gearless, water cooled synchronous drive, conveys the resin into a 60 mm screw sleeve with a length of 10 D. Inside the sleeve the material is plasticizied and discharged into the outer screw channel of the sleeve through radial bores. Only the solid bed remains inside. The development of a melt pool - and thus a decrease of the plasticizing capacity - is avoided. The sleeve is rotated by drag forces only (approximately 10 - 15 % of the screw speed). Due to the low speed of the screw sleeve molten material is conveyed to a 4 D Dynamic Mixing Ring in a gentle manner. The DMRs floating ring and the screw sleeve are directly coupled. The granules in the screw channel are stopped by a barrier on the screw in front of the mixing device. So nearly no unmelted material can pass the system. For temperature management in the plastification and mixing zone a 3-zone heating/air-cooling system is used. Various kinds of experiments with the High-Speed S-Truder were conducted. Reachable throughputs with different types of material (LDPE, LLDPE, PP, PS) have been tested. Also three screw geometries, which are mainly varying in the channel depth, were compared. Experimental results and theoretical background will be described in this paper.

  18. Laparoscopy-assisted gastrectomy with D2 lymph node dissection for advanced gastric cancer without serosa invasion: a matched cohort study from South China

    Science.gov (United States)

    2013-01-01

    Background Gastric cancer is a common malignancy worldwide and a common cause of death from cancer. Despite recent advances in multimodality treatment and targeted therapy, complete resection remains the only treatment that can lead to cure. This study was devised to investigate the technical feasibility, safety and oncologic efficacy of laparoscopy-assisted gastrectomy for advanced gastric cancer without serosa invasion. Methods A retrospective matched cohort study was performed in south China comparing laparoscopy-assisted gastrectomy and open gastrectomy for advanced gastric cancer without serosa invasion. Eighty-three patients with advanced gastric cancer undergoing laparoscopy-assisted gastrectomy between January 2008 and December 2010 were enrolled. These patients were compared with 83 patients with advanced gastric cancer undergoing open gastrectomy during the same period. Results There was no significant difference in clinicopathologic characteristics between the two groups. Regarding perioperative characteristics, the operation time and time to ground activities did not differ between the two groups, whereas the blood loss, transfused patient number, time to first flatus, time to resumption of diet, and postoperative hospital stay were significantly less in laparoscopy-assisted gastrectomy than in open gastrectomy (P Laparoscopy-assisted gastrectomy with D2 lymphadenectomy is a safe and feasible procedure for advanced gastric cancer without serosa invasion. To be accepted as a choice treatment for advanced gastric cancer, well-designed randomized controlled trials comparing short-term and long-term outcomes between laparoscopy-assisted gastrectomy and open gastrectomy in a larger number of patients are necessary. PMID:23311966

  19. Effects of total gastrectomy on plasma silicon and amino acid concentrations in men.

    Science.gov (United States)

    Tatara, Marcin R; Krupski, Witold; Szpetnar, Maria; Dąbrowski, Andrzej; Bury, Paweł; Szabelska, Anna; Charuta, Anna; Boguszewska-Czubara, Anna; Maciejewski, Ryszard; Wallner, Grzegorz

    2015-12-01

    The aim of the study was to determine one-year effects of total gastrectomy on plasma silicon and free amino acid concentrations in patients and evaluate changes of volumetric bone mineral density (vBMD) in lumbar spine. Eight patients were enrolled to the control (CTR) group. Six patients subjected to total gastrectomy (GX group) were included to the experimental group. vBMD in trabecular and cortical bone was measured in lumbar vertebrae at baseline (before surgery) and one year later using quantitative computed tomography. Plasma concentrations of silicon and free amino acids were determined at baseline and one year later using photometric method and ion-exchange chromatography. Body weights within CTR and GX groups were not different after one-year follow-up when compared to the baseline values (P > 0.05). An average annual decrease of vBMD in the trabecular bone in the gastrectomized patients reached 15.0% in lumbar spine and was significantly different in comparison to the percentage changes observed in CTR group (P = 0.02). One-year percentage change of vBMD in the cortical bone in L1 and L2 has shown significantly decreased values by 10.5 and 9.1% in the GX group when compared to the percentage change observed in the controls (P silicon was significantly lowered by 26.7% one year after the total gastrectomy when compared to the baseline value (P = 0.009). Total gastrectomy in patients has induced severe osteoporotic changes in lumbar spine within one-year period. The observed osteoporotic changes were associated with decreased plasma concentration of silicon indicating importance of exocrine and endocrine functions of stomach for silicon homeostasis maintenance. Gastrectomy-induced bone loss was not related to decreased amino acid concentration in plasma obtained from overnight fasted patients. © 2015 by the Society for Experimental Biology and Medicine.

  20. Surgical advantages of reduced-port laparoscopic gastrectomy in gastric cancer.

    Science.gov (United States)

    Kunisaki, Chikara; Makino, Hirochika; Yamaguchi, Naotaka; Izumisawa, Yusuke; Miyamato, Hiroshi; Sato, Kei; Hayashi, Tsutomu; Sugano, Nobuhiro; Suzuki, Yoshihiro; Ota, Mitsuyoshi; Tsuburaya, Akira; Kimura, Jun; Takagawa, Ryo; Kosaka, Takashi; Ono, Hidetaka Andrew; Akiyama, Hirotoshi; Endo, Itaru

    2016-12-01

    Although a few studies have reported the use of reduced-port laparoscopic gastrectomy (RPG) in gastric cancer patients, the feasibility of routinely using this technique remains unclear. It is therefore important to evaluate the surgical advantages of this technique in this patient group. Between August 2010 and July 2015, 165 patients underwent RPGs at our hospital, performed by a single surgeon. Of these patients, 88 underwent reduced-port laparoscopic distal gastrectomy (RPLDG) and 77 underwent reduced-port laparoscopic total gastrectomy (RPLTG). In addition to short-term surgical outcomes after RPG, survival times and the surgical learning curve were also evaluated. Blood losses during lymph node dissection in the RPLDG and RPLTG groups were not significantly different (p = 0.160). Conversion to open surgery was necessary in only two patients. Postoperative morbidities were observed in 14.8 % of the RPLDG group and 14.3 % of the RPLTG group, but there were no deaths. Most patients expressed high cosmetic satisfaction in both groups. In the RPLDG group, operation time during reconstruction decreased over the first 50 cases and then plateaued, as the surgeon's experience of the technique increased. In contrast, in the RPLTG group, operation times dropped with surgical experience for both lymph node dissection, plateauing after 40 cases, and for reconstruction, plateauing after 30 cases. Only three patients died of gastric cancer in the follow-up period and three patients died of other diseases. Five-year overall survival and 5-year disease-specific survival were 95.6 and 98.0 %, respectively. We have shown that reduced-port gastrectomy (RPG) could be an acceptable and satisfactory procedure for treating gastric cancer for an experienced laparoscopic gastric surgeon who has sufficient previous experience of conventional laparoscopic gastrectomies.

  1. Anticorrosive field joint coating qualification, heat shrinkable sleeve; Qualificacao de revestimento anticorrosivo para juntas de campo, mantas termocontrateis

    Energy Technology Data Exchange (ETDEWEB)

    Cabral, Glaucia B.; Koebsch, Andre; Castinheiras Junior, Wilson [PETROBRAS, Rio de Janeiro, RJ (Brazil)

    2005-07-01

    The main objective of this job is to present the quality requirements fixed by PETROBRAS for anticorrosive field joint coating for buried pipelines, industrially coated with PE-3L. It describes the used system - polyethylene based heat shrinkable sleeve - comparing with the existent on the pipeline. So, it exposes the suppliers' qualification stages, which include test carried out for the materials, for the sleeve set and for the coating after its application on the joint field. Finally, it shows that the experience, which has been gotten in the qualification, consolidated the quality control systematic that have been carry out during the sleeves acquisition and application at the pipeline construction. (author)

  2. Diagnostic and therapeutic endoscopic retrograde cholangiopancreaticography after Billroth II gastrectomy--safe provision in a district general hospital.

    OpenAIRE

    Swarnkar, K.; Stamatakis, J. D.; Young, W. T.

    2005-01-01

    INTRODUCTION: Endoscopic retrograde cholangiopancreaticography (ERCP) is available in many district general hospitals in the UK. Most of the published literature on ERCP in cases with Billroth II gastrectomy reflects teaching hospital experience. The aim of this study was